Ficat and Arlet classification of avascular necrosis of femoral head

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

  • 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

Professor R.P. Ficat in association with Professor J. Arlet devised a system of staging idiopathic avascular necrosis of femoral head in the late 70s based on two fundamental concepts 2

  1. A standard radiograph shows only the shadow of the mineralized portion of a bone. 
  2. Bone necrosis is the end result of severe and prolonged ischaemia.
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Article information

rID: 951
Tags: hip, aps, ficat
Synonyms or Alternate Spellings:
  • ficat staging
  • ficat classification
  • ficat and arlet classification
  • ficat and arlet staging

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Cases and figures

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    Case 1: stage II
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    Case 2: stage III
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    Case 3: stage IV
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     Case 4: stage III
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    Case 5: stage II
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    Case 6: stage IV
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    Case 7: stage III
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