Avascular necrosis of the hip classification

The Ficat classification is a commonly used system to stage AVN of the hip, and uses a combination on plain radiograph, MRI and clinical features:

  • stage 0
    • plain radiograph: normal
    • MRI: normal
    • clinical symptoms: nil
  • stage I
    • plain radiograph: normal or minor osteopaenia
    • MRI: oedema
    • 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 film
    • 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

See also

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