The purposes of this study were to evaluate how accurately current imaging modalities predict the quality of the articular surface in avascular necrosis (AVN) of the femoral head and to provide arthroscopic correlation to current staging modalities. An arthroscopic classification system, derived from the work of Marcus et al, was used to prospectively stage the articular surface in 23 hips with AVN using plain radiographs, magnetic resonance imaging (MRI), and arthroscopy. There was little correlation between all three diagnostic modalities. These findings were not statistically significant. Patients with stage IV disease had the widest variation in the appearance of the articular surface. This study shows poor correlation in the staging of AVN using current imaging techniques. Magnetic resonance imaging has been shown to be inadequate at assessing the articular cartilage. Therefore, either arthroscopy or direct visualization is required for accurate evaluation and staging, especially in stage IV disease.