Site icon Elearn Radiology

Ficat and Arlet staging of hip avascular necrosis


Professor R.P. Ficat and professor J. Arlet in the late 70s devised a staging system for idiopathic bone necrosis of femoral head based on two fundamental concepts:

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


Stage 0

Stage I

Stage II

Transition phase

Stage III

Stage IV

Two variations identified
  1. Ischaemic coxopathy
    • narrowing of joint space in early stages of disease – generalized or confined to superomedial quadrant
    • mis diagnosed as primary osteoarthritis in early stages
    • seen in 6th decade
    • sudden onset with pain in night
    • morphologically normal as well as dysplastic hips
  2. Bilateral involvement
    • 50% cases of idiopathic bone necrosis
    • 80% of steroid associated bone necrosis
    • frequently asymmetrical involvement

Read more

Ficat, R. P. “Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment.”Bone & Joint Journal 67.1 (1985): 3-9.



Exit mobile version