Steinberg (University of Pennsylvania) staging

A quantitative system for staging avascular necrosis.

Steinberg ME, Hayken GD, Steinberg DR. The Journal of bone and joint surgery. British volume 1995 · PMID 7822393 · doi:10.1302/0301-620x.77b1.7822393

Question

Can avascular necrosis of the femoral head be staged in a way that also quantifies lesion size and extent?

Design

Description of a staging system with application to a clinical cohort.

Patients

Patients with avascular necrosis of the femoral head.

Intervention

Steinberg staging (stages 0-VI with A/B/C extent grading)

Comparison

Earlier staging systems such as Ficat and Arlet

Primary outcome

Staging categories and their relation to outcome

Key result

Extended Ficat-type staging by incorporating MRI findings and quantifying the extent of head involvement, which helps predict progression and guide treatment.

Limitations

More complex than Ficat staging and inter-observer reliability is imperfect.

Impact on practice

Steinberg (alongside Ficat and ARCO) staging is used to describe osteonecrosis and decide between head-preserving surgery and arthroplasty, and is commonly examined.