Diagnostic methods and classifications of aseptic necrosis of the femoral head

I.M. Zazirnyi, V.G. Klimovytskyi, I.P. Semeniv, O.M. Mikhalchenko, B.S. Ryzhkov


Aseptic femoral head necrosis (AFHN) is a common hip joint disease. AFHN is not a specific process, but rather the end of a series of disorders that lead to a decrease in blood flow in the femoral head, which leads to cell necrosis. In most cases, diagnosis is made in the later stages of the disorder, when surgical treatment that can preserve the femoral head and prevent destruction of the hip joint is no longer shown. This usually affects middle-aged patients who are more active. Therefore, many surgeons are trying to delay their performance of total hip replacement. Patient analysis and comparison are problematic and have difficulty assessing progression and determining the stage of the disease without a commonly recognized classification system and data collection method. Several ANFH classification systems are described and used. Currently, the most commonly used classifications include Ficat, Steinberg, Association Research Circulation Osseous (ARCO), and the Japan Investigation Committee (JIC). Several other classification systems, such as Kerboul et al., Are less commonly used. Each classification evaluates a slightly different criterion in the assessment of the ANSP. While Ficat uses conventional radiographs to determine the stage and progression of the disease, Steinberg combined radiographs and magnetic resonance imaging (MRI) to estimate the extent of the lesion. The ARCO system improved the Ficat classification by including radiographs, computed tomography, MRI and scintigraphy to determine the size and location of the necrotic area [16]. The JIC classification, adopted by the Ministry of Health, Labor and Welfare of Japan, uses the T1 weighted MRI regimen to classify osteonecrosis based on the localization of necrotic lesions. Classification systems provide the orthopedist with the opportunity to differentiate this clinically complex disease according to severity, prognosis, and indications for different treatment options. The success of the ANFH treatment is directly related to the stage of the lesion. As soon the diagnosis is made, the greater the chance to influence the mechanisms of development of this pathology. Clinical symptoms usually precede radiological changes, so suspicion of the development of ANFH and the appointment of appropriate diagnostic techniques is an important point in the timely diagnosis. We wanted to show the most commonly used ANFH classification systems and the important factors to consider in each in this review.


aseptic necrosis; femoral head; diagnosis; classifications; review


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