The three methods that are currently used are Ficat staging, Steinberg staging and ARCO staging. Stage I: Ficat et al. (1980) proposed a well-established four-stage staging system based on the radiographic presentation and functional bone examination (including measurement of intertrochanteric pressure, intramedullary venography and core biopsy). have symptoms of pain and limited hip movement, and functional examination of bone may detect positive results; stage II: X-ray shows extensive osteoporosis, with osteosclerosis or cystic changes, normal contour of the femoral head, histopathological changes in the medullary core biopsy, and obvious clinical symptoms; stage III: X-ray shows sclerosis and cystic changes within the femoral head, collapse of the femoral head with crescentic sign, normal joint space, and obvious increase in clinical symptoms; stage IV Stage IV: osteoarthritis stage, X-rays show collapse of the femoral head, narrowing of the joint space, obvious clinical symptoms and pain, and obvious restriction of hip joint movement in all directions. In the 1970s, Ficat proposed a four-stage staging method for adult osteonecrosis of the femoral head, and Marcus also proposed a four-stage, six-type staging method, but it was mostly limited to clinical symptoms and X-ray changes, which had certain limitations for early diagnosis. Based on long-term clinical observation, we propose a comprehensive staging method based on clinical, X-ray, CT, ECT and MRI. This method can detect suspicious cases at an early stage and help guide the selection of clinical treatment plan and the estimation of disease prognosis. Stage I: clinical manifestations, progressive pain in the hip and knee joint, mild restriction of hip joint movement, X-ray manifestations, normal appearance of the femoral head, slightly blurred cartilage and trabecular structures, or patchy osteoporosis, CT, mild thickening of the trabecular bone in the middle of the femoral head, stellate structure, radiating or or pseudo-foot-like branching arrangement to the soft same part of the femoral head, some small cystic changes visible in the subchondral area, ECT with early concentrations. The arterial blood supply is low, and MRI shows low signal and abnormal changes. Stage II: Hip pain is the main cause, abduction and internal rotation are mildly restricted, X-ray shows subchondral cystic changes, bone tissue destruction and sparing intertwined phenomenon, also visible in the cartilage area half-moon shaped translucent area, called “crescent sign”, CT can be seen in the subchondral bone marrow cavity part of the bone trabeculae hard human changes. Part of the subchondral bone marrow wrist trabecular sclerosis change. Cystic changes in the subchondral bone marrow cavity over 0.5 cm, ECT shows a large “hot zone” (depressed blood) or a large “cold zone” (ischemia) in the resting phase, and there is an intermediate phase of hot and cold intermingling, MRI, a large low signal area. Stage III: Hip and knee pain is aggravated, weight-bearing endurance is decreased, claudication, X-ray shows subchondral microfracture, partial interruption of trabecular continuity, collapse and flattening of the weight-bearing area above the femoral head or fragmented bone fragments under the cartilage, CT shows disturbed trabecular bone within the femoral head, enlarged cystic area, bone fragmentation, femoral head deformation, partial area of hyperplasia and sclerosis, acetabular osteophytes, ECT and MRI shows more obvious than stage II. Stage IV: Restriction of hip joint movement, difficulty in walking in severe cases, or loss of labor ability, X-ray shows joint space narrowing, flattened and collapsed deformity of femoral head, hyperplasia and deformation of acetabular rim, hyperplasia and deformation of acetabular rim, showing osteoarthritic changes, CT shows deformation of femoral head contour, joint space narrowing, intermingling of femoral head sclerosis and cystic change, fragmentation of bone structure, etc. ECT shows local concentration at the junction of socket head, blood pool ECT showed localized concentration at the malleolar junction, reduced slope of the blood pool, and more pronounced low signal areas on MRI than stage II and III. In 2002, scholars from The University of Pennsylvania proposed their staging method based on the X-ray plain film and bone scan examination methods of femoral head necrosis combined with MRI performance. The University of Pennsylvania staging Stage 0 Plain radiographs, bone scans and MRI are normal Stage I Plain radiographs are normal, bone scans or/and MRI show abnormalities A-Mild femoral head lesion extent <15% B-Moderate 15-30% C-Severe:>30% Stage II Femoral head shows translucency and sclerotic changes A-Mild:<15% B-Moderate:15-30% C-Severe:>30% Stage III Subchondral collapse (crescent A mild:<15% articular surface length B moderate:15-30% articular surface length C severe:>30% articular surface length Stage IV femoral head flattening A mild:<15% articular surface or collapse <2-mm B moderate:15-30% articular surface or collapse 2-4-mm C severe:>30% articular surface or collapse >4-mm Stage V joint stenosis or acetabular lesion A mild B moderate C severe Stage VI severe degenerative changes III International Staging of Femoral Head Necrosis (ARCO) Stage 1 positive bone scan or/and MRI A MRI femoral head lesion extent <15% B femoral head lesion extent 15-30% C femoral head lesion extent >30% Stage 2 patchy uneven density, sclerosis and cyst formation in the femoral head, no manifestation of collapse on plain film and CT, MRI and bone scan Positive, no change in acetabulum A MRI femoral head lesion range <15% B MRI femoral head lesion range 15-30% C MRI femoral head lesion range >30% Stage 3 Crescentic sign on frontal and lateral views A crescentic sign length <15% of articular surface or collapse less than <2-mm B crescentic sign length - 15-30% of articular surface length or collapse 2-4mm C crescentic sign length >30% of articular The longer the length of the articular surface or collapse >4-mm stage 4, the flattening of the articular surface, narrowing of the joint space, necrotic changes in the acetabulum, cystic changes, cysts and bone spurs, the greater the extent of the necrotic lesion, the worse the prognosis, and one of the disadvantages of Ficat staging is that there is no quantitative standard, and there is no link between the extent of the lesion, its degree and the staging. The Ficat staging is usually used to determine the imaging score when judging the treatment effect by the scorekeeping method, even if the lesion extent increases, the score will not decrease, and there will be a paradoxical phenomenon that the lesion extent increases but the score does not decrease on the photograph. The ARCO staging puts subchondral fracture and femoral head collapse in one stage, and puts mild joint space narrowing and severe osteoarthrosis in the same stage, and we find in our daily work that there is a big difference in the treatment effect of subchondral fracture and femoral head collapse, and the treatment effect of mild and severe osteoarthritis is also different. steinberg staging is more reasonable, and we use it to judge our treatment effect.