Developing International Clinical Practice Guidelines: Lessons Learned in Achieving Global Consensus for the Association Research Circulation Osseous Guideline.

Abstract

The development of international clinical practice guidelines (CPGs) offers an opportunity to harmonize evidence-based care across diverse health care systems, but presents substantial logistical, methodological, and implementation challenges. These challenges are particularly pronounced for nontraumatic osteonecrosis of the femoral head (ONFH), a condition characterized by heterogeneous disease biology, evolving diagnostic criteria, and limited high-certainty evidence. This article summarizes key lessons learned during the development of the first international, evidence-based CPG for ONFH led by the Association Research Circulation Osseous (ARCO). Key lessons emerged across multiple domains, including optimization of panel structure and workflow, effective use of virtual collaboration platforms, early engagement of methodological experts, refinement of literature search and data abstraction approach, and staged formulation and approval of recommendations. Additional insights highlighted the need to anticipate global variability in resources, language, and clinical context, underscoring the value of resource-stratified recommendations, early planning for translation and cultural adaptation, incorporation of patient values and preferences, and linkage of guideline recommendations to measurable quality indicators to assess real-world uptake and impact. Collectively, these lessons emphasize that international guideline development should adopt a life-cycle approach extending beyond publication to promote equitable adoption, continuous refinement, and meaningful improvements in patient care worldwide.