# Ficat — Ficat classification of avascular necrosis of the femoral head

> Stages osteonecrosis of the femoral head.

**Situação:** vigente · **Órgão:** Musculoesquelético · **Órgão emissor:** Orthopedic consensus · **Versão:** 1985 · **Ano:** 1985

## Procedência e vigência
- Família: léxico
- Tipo de lógica: flat
- Modalidade: XR, MRI
- Fonte primária: Ficat RP. Idiopathic bone necrosis of the femoral head (Ficat) (1985) — https://en.wikipedia.org/wiki/Avascular_necrosis
- Última verificação: 2026-06-26
- Última checagem: 2026-06-26

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| 0 | 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). | Pre-collapse stage: non-operative/observation (e.g. bisphosphonates) and joint-preserving options; close monitoring given the risk of progression to symptoms or collapse. | Asymptomatic early lesions carry substantial risk of progression: about 59% of asymptomatic lesions progress to symptoms or collapse. | PMC2323428 Table 1 (criteria); NBK537007 (non-operative/joint-preserving for early stages; 59% of asymptomatic lesions progress). | ✓ |
| I | Grade I | Symptomatic hip with radiographs still normal or showing only minor changes (e.g. slight patchy osteoporosis); femoral head shape preserved. | Pre-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. | Pre-collapse but progressive; core decompression failed to prevent progression in roughly 90% of treated hips, reflecting the high rate of eventual collapse. | PMC2323428 Table 1 (criteria); NBK537007 (core decompression for early stages; ~90% core-decompression failure). | ✓ |
| II | 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. | Still 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. | Once the crescent sign / subchondral fracture appears, progression to collapse is common and joint-preserving procedures are less likely to succeed. | PMC2323428 Table 1 (criteria, incl. crescent sign); NBK537007 (joint-preserving most effective in early stages/small lesions). | ✓ |
| III | Grade III | Broken/disrupted contour of the femoral head with bone sequestrum (true segmental collapse) while the joint space remains normal/preserved. | Post-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. | Segmental collapse has occurred; the joint is no longer salvageable by joint-preserving surgery and degenerative end-stage disease typically follows. | PMC2323428 Table 1 (criteria); NBK537007 (total hip arthroplasty indicated for advanced collapse / age >40 / large lesions). | ✓ |
| IV | Grade IV | End stage: flattened femoral head contour, joint-space narrowing/collapse, and secondary osteoarthritic (degenerative) changes of the joint. | Post-collapse end stage: total hip arthroplasty (joint replacement) is the definitive treatment. | Irreversible end-stage osteoarthritic destruction of the hip; joint-preserving options no longer applicable. | PMC2323428 Table 1 (criteria); NBK537007 (total hip arthroplasty for advanced/end-stage disease). | ✓ |

### Citações por categoria
- **0**: Ficat RP. Idiopathic bone necrosis of the femoral head (Ficat) (1985) — https://en.wikipedia.org/wiki/Avascular_necrosis · PMC2323428 Table 1 (criteria); NBK537007 (non-operative/joint-preserving for early stages; 59% of asymptomatic lesions progress).
- **I**: Ficat RP. Idiopathic bone necrosis of the femoral head (Ficat) (1985) — https://en.wikipedia.org/wiki/Avascular_necrosis · PMC2323428 Table 1 (criteria); NBK537007 (core decompression for early stages; ~90% core-decompression failure).
- **II**: Ficat RP. Idiopathic bone necrosis of the femoral head (Ficat) (1985) — https://en.wikipedia.org/wiki/Avascular_necrosis · PMC2323428 Table 1 (criteria, incl. crescent sign); NBK537007 (joint-preserving most effective in early stages/small lesions).
- **III**: Ficat RP. Idiopathic bone necrosis of the femoral head (Ficat) (1985) — https://en.wikipedia.org/wiki/Avascular_necrosis · PMC2323428 Table 1 (criteria); NBK537007 (total hip arthroplasty indicated for advanced collapse / age >40 / large lesions).
- **IV**: Ficat RP. Idiopathic bone necrosis of the femoral head (Ficat) (1985) — https://en.wikipedia.org/wiki/Avascular_necrosis · PMC2323428 Table 1 (criteria); NBK537007 (total hip arthroplasty for advanced/end-stage disease).


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> Conteúdo de referência reescrito. Confira a publicação primária vigente. Não é dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

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