CORRELATION BETWEEN FICAT-ARLET AND MITCHELL’S STAGING FOR AVASCULAR NECROSIS OF FEMUR HEAD

Abstract

Introduction: Avascular necrosis (AVN) of the femoral head is an increasingly common cause of musculoskeletal disability, and it poses a major diagnostic and therapeutic challenge. Surgical management involves joint preserving surgeries in early stages of disease and joint replacement procedures in advanced stage disease. Thus, pre-operative staging is of utmost importance in deciding the appropriate treatment option.

Objective: The objective of the study was to stage avascular necrosis involving head of femur according to Ficat-Arlet (using X-RAY and MRI features) and Mitchell staging (using MRI features) and to study the correlation amongst the above mentioned staging systems.

Methodology: X-RAY and MRI images of thirty patients having Avascular Necrosis of femur head (23-bilateral and 7-unilateral) were studied retrospectively and staged according to Ficat-Arlet and Mitchell staging.

Results: Most of the Ficat-Arlet stage I and stage II joints (early stage) had Class A signal on MRI and most of the Ficat-Arlet stage III and stage IV joints (advanced stage) had class B or class C signal on MRI. Most of the affected joints with class A signal in the necrotic core had early stage disease while those with class B or class C signal had advanced stage disease.

Conclusions: Our study suggests that Mitchell’s MRI staging for Avascular necrosis involving head of femur may have prognostic significance and Mitchell’s MRI staging may be used in surgical decision making (joint preservation versus joint replacement).