Stages of Avascular Necrosis/Osteonecrosis 

The Different Stages of Osteonecrosis aka (Avascular Necrosis)
There are a lot of people who are trying to find out information about the different stages of osteonecrosis aka(avascular necrosis). 

Most stages are based on ON(AVN) of the hips, as those are the joints most commonly affected. However, any joint can be affected by ON (AVN). 

The second most common joints affected are the knees.
There are the Ficat and the Steinberg Classification systems. 

Most orthopedic doctors use the Ficat classification system to determine at what stage your disease is. 

The stages are as follows:

Stage I: 

* X-Ray: ON (AVN) is not detectable.

* MRI: there might appear slight bone marrow edemaor joint effusion. Joint effusion most commonly appears in the knees.

* Bone Scan: evidence of increased uptake. Increased uptake is mainly due to increased activity of osteoblasts (cells responsible for bone formation) associated with new bone formation, and to a lesser degree by increased blood flow to bone. Increased uptake is an indication that there might be a tumor, fracture or infection.

Stage II:

* X-Ray: mixed osteopenia, a condition where bone mineral density is lower than normal, or evidence of sclerosis(abnormal hardening of body tissue)

* MRI: evidence of lesion; an abnormality in bone tissue.

* Bone Scan: increased uptake (Increased uptake is an indication that there might be a tumor, fracture or infection)

Stage III:

* X-ray & MRI: bone collapse of joint appears imminent.

Stage IV:

* X-ray & MRI: collapse of joint.

A lot of websites, talking about Ficat Classification, refer to the level of pain at each stage of the disease. 
One indication of early ON (AVN) in the hips is pain in the groin. However, it appears to me that the pain differs from one ON (AVN) sufferer to another. 
My ON (AVN) is in my knees and the first time I felt pain was in my knee cap when I tore my meniscus 
As the disease worsened or progressed the pain ran like hot rods all around my knee . Yet to feel my knee it was cold very cold on the outside 

Of course 

Every body is different.


It depends on where your ON(AVN) is.  

If it is in more than one bone or joint. 

ON/AVN pain is not like any other pain
The bone is starving for blood to keep it alive
That’s why it’s always good to ask what stage is your ON/AVN.




2 thoughts on “Stages of Avascular Necrosis/Osteonecrosis 

  1. I had AVN in my left hip. I was diagnosed with a CT scan. I can’t have MRI’s, so that was as close as they could get.
    It didn’t show anything in Oct by February I was pushing Stage 3. I had my hip replaced that April. It was collapsing when he got in there.
    It can happen fast. (This was 2014 -2015)
    Or it can take its time. We are all different.
    I’m just happy a replacement took it away. I know I have an increased risk for other joints, especially my other hip. But so far so good.
    The replacement hurt much less than the AVN.
    Thanks for the breakdown of the stages.

    Liked by 2 people

Comments are closed.

Blog at

Up ↑

%d bloggers like this: