Ficat and Arlet staging of avascular necrosis of femoral head

The Ficat and Arlet staging, at time of writing (mid 2016), is a commonly used system to stage AVN of the hip, and uses a combination on plain radiograph, MRI and clinical features

History and Etymology

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 concepts2

  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.

Classification

  • 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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Article Information

rID: 951
System: Musculoskeletal
Section: Classifications
Tags: hip, aps, ficat
Synonyms or Alternate Spellings:
  • ficat staging
  • ficat classification
  • ficat and arlet classification
  • ficat and arlet staging
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    Case 1: stage II
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    Case 5: stage II
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    Case 7: stage III
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