avascular necrosis of the hip classification

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The Ficat and Arlet classification uses a combination of plain radiographs, MRI, and clinical features to stage avascular necrosis of the femoral head.

Classification

  • stage 0
    • plain radiograph: normal
    • MRI: normal
    • clinical symptoms: nil
  • stage I
    • plain radiograph: normal or minor osteopenia
    • MRI: edema
    • bone scan: increased uptake
    • clinical symptoms: pain typically in the groin
  • stage II
    • plain radiograph: mixed osteopenia and/or sclerosis and/or subchondral cysts, without any subchondral lucency (crescent sign: see below)
    • MRI: geographic defect
    • bone scan: increased uptake
    • clinical symptoms: pain and stiffness
  • stage III
    • plain radiograph: crescent sign and eventual cortical collapse
    • MRI: same as plain radiograph
    • clinical symptoms: pain and stiffness +/- radiation to knee and limp
  • stage IV
    • plain radiograph: end-stage with evidence of secondary degenerative change
    • MRI: same as plain radiograph
    • clinical symptoms: pain and limp

History and etymology

The French orthopedic surgeon Paul (RP) Ficat (1917-1986) in association with Professor Jacques Arlet devised a system of staging idiopathic avascular necrosis of femoral head in the late 1970s based on two fundamental concepts :

  • a standard radiograph shows only the shadow of the mineralized portion of a bone
  • bone necrosis is the end result of severe and prolonged ischemia

    • See also

    Siehe auch:
    und weiter:
    Assoziationen und Differentialdiagnosen zu Ficat staging:
    Aseptische
    Knochennekrose
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