Ficat

classification of avascular necrosis of the femoral head

Stages osteonecrosis of the femoral head.

vigenteOrthopedic consensus1985XR, MRI

0Grade 0 IGrade I IIGrade II IIIGrade III IVGrade IV

Aplicar o Ficat a um achado

Descreva o achado como no laudo. A resposta aponta uma das categorias publicadas, com a probabilidade e o trecho que a decide.

Categorias

Reescritas a partir da fonte e citadas

1 de 5

Grade 0

Preclinical/silent hip: radiographs normal (inconspicuous) and the patient is asymptomatic; diagnosis suspected only by other means (e.g. MRI, opposite-hip disease).

CondutaPre-collapse stage: non-operative/observation (e.g. bisphosphonates) and joint-preserving options; close monitoring given the risk of progression to symptoms or collapse.

RiscoAsymptomatic early lesions carry substantial risk of progression: about 59% of asymptomatic lesions progress to symptoms or collapse.

verificadoIdiopathic bone necrosis of the femoral head (Ficat)PMC2323428 Table 1 (criteria); NBK537007 (non-operative/joint-preserving for early stages; 59% of asymptomatic lesions progress).

2 de 5

Grade I

Symptomatic hip with radiographs still normal or showing only minor changes (e.g. slight patchy osteoporosis); femoral head shape preserved.

CondutaPre-collapse: joint-preserving surgery, particularly core decompression (most effective in early disease with small weight-bearing involvement), with/without bone grafting or biologic adjuncts; non-operative measures may be used.

RiscoPre-collapse but progressive; core decompression failed to prevent progression in roughly 90% of treated hips, reflecting the high rate of eventual collapse.

verificadoIdiopathic bone necrosis of the femoral head (Ficat)PMC2323428 Table 1 (criteria); NBK537007 (core decompression for early stages; ~90% core-decompression failure).

3 de 5

Grade II

Radiographic changes without overall head collapse: diffuse or focal osteoporosis, sclerosis, and cysts (Ficat IIA), progressing to a subchondral fracture (crescent sign) with segmental flattening (Ficat IIB); joint space preserved.

CondutaStill considered pre-/peri-collapse: joint-preserving core decompression (+/- grafting) for lesions before frank collapse, most effective when the lesion is small and limited to a small part of the weight-bearing surface.

RiscoOnce the crescent sign / subchondral fracture appears, progression to collapse is common and joint-preserving procedures are less likely to succeed.

verificadoIdiopathic bone necrosis of the femoral head (Ficat)PMC2323428 Table 1 (criteria, incl. crescent sign); NBK537007 (joint-preserving most effective in early stages/small lesions).

III

4 de 5

Grade III

Broken/disrupted contour of the femoral head with bone sequestrum (true segmental collapse) while the joint space remains normal/preserved.

CondutaPost-collapse: total hip arthroplasty is indicated, especially for irreversible etiology, patients over 40, large lesions, or advanced collapse; younger patients with advanced collapse also move toward arthroplasty.

RiscoSegmental collapse has occurred; the joint is no longer salvageable by joint-preserving surgery and degenerative end-stage disease typically follows.

verificadoIdiopathic bone necrosis of the femoral head (Ficat)PMC2323428 Table 1 (criteria); NBK537007 (total hip arthroplasty indicated for advanced collapse / age >40 / large lesions).

5 de 5

Grade IV

End stage: flattened femoral head contour, joint-space narrowing/collapse, and secondary osteoarthritic (degenerative) changes of the joint.

CondutaPost-collapse end stage: total hip arthroplasty (joint replacement) is the definitive treatment.

RiscoIrreversible end-stage osteoarthritic destruction of the hip; joint-preserving options no longer applicable.

verificadoIdiopathic bone necrosis of the femoral head (Ficat)PMC2323428 Table 1 (criteria); NBK537007 (total hip arthroplasty for advanced/end-stage disease).

Lógica de decisão estruturada

{
  "categories": [
    "0",
    "I",
    "II",
    "III",
    "IV"
  ]
}

Referência, não é dispositivo médico. Confira a publicação primária vigente. O radiologista que assina o laudo continua autor e responsável.