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Ficat and Arlet classification of osteonecrosis of the femoral head

Last revised by Ciléin Kearns ◉ on 2 Nov 2024

Citation, DOI, disclosures and article data

Citation:

Gaillard F, Kearns C, Niknejad M, et al. Ficat and Arlet classification of osteonecrosis of the femoral head. Reference article, Radiopaedia.org (Accessed on 09 Dec 2024) https://doi.org/10.53347/rID-951

DOI:

https://doi.org/10.53347/rID-951

Permalink:

https://radiopaedia.org/articles/951

rID:

951

Article created:

2 May 2008, Frank Gaillard ◉ ◈

Disclosures:

At the time the article was created Frank Gaillard had no recorded disclosures.

View Frank Gaillard's current disclosures

Last revised:

2 Nov 2024, Ciléin Kearns ◉

Disclosures:

At the time the article was last revised Ciléin Kearns had no financial relationships to ineligible companies to disclose.

View Ciléin Kearns's current disclosures

Revisions:

34 times, by 26 contributors - see full revision history and disclosures

Systems:

Musculoskeletal

Sections:

Classifications

Tags:

hip, aps, ficat

Synonyms:

ficat staging
ficat classification
ficat and arlet classification
ficat and arlet staging

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

stage 0
- plain radiograph: normal
- MRI: normal
- clinical symptoms: nil
stage I
- plain radiograph: normal or minor osteopenia
- 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
- 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 orthopaedic surgeon R Paul Ficat (1917-1986 ⁴)in association with Professor Jacques Arlet devised a system of staging idiopathic osteonecrosis of the femoral head in the late 1970s based on two fundamental concepts ²:

a standard radiograph shows only the shadow of the mineralised portion of a bone
bone necrosis is the end result of severe and prolonged ischaemia

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Ficat and Arlet classification of osteonecrosis of the femoral head

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