In femoral head necrosis, the bone tissue of the femoral head dies due to a lack of blood circulation (ischemia). Causes of the circulatory disorder can be an injury to the hip joint, various diseases, cortisone and chemotherapy, radiation, as well as obesity and alcohol abuse. Metabolic disorders, alcoholism or trauma can promote the development of femoral head necrosis.
The “destruction” of parts of the bone results in a deformation of the femoral head. As a result, it no longer “fits” optimally into the acetabulum, resulting in pain and increasing wear and tear of the hip joint (coxarthrosis). There are two different stages in the course of a femoral head necrosis: The classification according to ARCO classifies the femoral head necrosis according to the joint changes visible in imaging procedures, whereas the classification according to Ficat/Arlt additionally takes into account the occurring symptoms.
Stadiums after Ficat and Arlet
The stage classification of femoral head necrosis according to Ficat/Arlet is based not only on the findings of the x-ray but also on the patient’s symptoms: Stage 0: The patient has no complaints. Stage 1: Pain occurs in the groin area during exercise, the hip joint is slightly restricted in movement. Stage 2: The X-ray shows the first changes such as the formation of cysts on the femoral head or sclerotherapy (increase in the bone tissue below the joint cartilage).
Stage 3: The patient also has pain at rest, the movement of the hip joint is moderately to severely restricted. The X-ray shows that parts of the cartilage have died off, which leads to a deformation of the femoral head. Stage 4: The femoral head has collapsed and signs of wear due to arthrosis are visible on the cartilage.
Stadiums according to ARCO
The ARCO classification of femoral head necrosis was developed in 1992 by the “Association Research Circulation Osseous”. It assesses the stages of femoral head necrosis according to the changes that can be detected during imaging diagnostics. The following radiological methods are used:
- X-ray
- MRI (
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