Table 1.

University of Pennsylvania Classification of OST

StageCriteria
Normal or nondiagnostic radiograph, bone scan, and MRI 
Normal radiograph: abnormal bone scan and/or MRI 
 A ‒ Mild (<15% of head affected) 
B ‒ Moderate (15%-30%) 
C ‒ Severe (>30%) 
II Lucent and sclerotic changes in femoral head 
 A ‒ Mild (<15%) 
B ‒ Moderate (15%-30%) 
C ‒ Severe (>30%) 
III Subchondral collapse (crescent sign) without flattening 
 A ‒ Mild (<15% of articular surface) 
B ‒ Moderate (15%-30%) 
C ‒ Severe (>30%) 
IV Flattening of femoral head 
 A ‒ Mild (<15% of surface and <2-mm depression) 
B ‒ Moderate (15%-30% of surface or 2- to 4-mm depression) 
C ‒ Severe (>30% of surface or >4-mm depression) 
Joint narrowing and/or acetabular changes 
 A ‒ Mild  
B ‒ Moderate 
C ‒ Severe 
VI Advanced degenerative changes 
StageCriteria
Normal or nondiagnostic radiograph, bone scan, and MRI 
Normal radiograph: abnormal bone scan and/or MRI 
 A ‒ Mild (<15% of head affected) 
B ‒ Moderate (15%-30%) 
C ‒ Severe (>30%) 
II Lucent and sclerotic changes in femoral head 
 A ‒ Mild (<15%) 
B ‒ Moderate (15%-30%) 
C ‒ Severe (>30%) 
III Subchondral collapse (crescent sign) without flattening 
 A ‒ Mild (<15% of articular surface) 
B ‒ Moderate (15%-30%) 
C ‒ Severe (>30%) 
IV Flattening of femoral head 
 A ‒ Mild (<15% of surface and <2-mm depression) 
B ‒ Moderate (15%-30% of surface or 2- to 4-mm depression) 
C ‒ Severe (>30% of surface or >4-mm depression) 
Joint narrowing and/or acetabular changes 
 A ‒ Mild  
B ‒ Moderate 
C ‒ Severe 
VI Advanced degenerative changes 

Reprinted from Lee et al17  with permission.

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