- M.B.B.S.
- M.S. Orthopaedics
- Fellow in Knee and Hip Replacement, Mumbai
- Fellow In Knee and Hip Surgery, Germany
- Fellow in Knee and Hip Surgery, NHS, Singapore
- Fellowship in Complex and revesion knee and Hip replacement, London, Lancaster, UK
Avascular necrosis of the hip, also called AVN or osteonecrosis, is a condition where the ball of the hip joint loses blood supply. When bone does not receive enough blood, it weakens and may gradually collapse.
The most important thing to understand is timing. In early stages, AVN may be managed with joint-preserving treatment in selected patients. Once the femoral head collapses and arthritis develops, hip replacement often becomes the more reliable option. AAOS notes that treatment choices depend on the stage and size of osteonecrosis and that core decompression may help prevent progression in some early cases
Why AVN Is Often Missed Early?
Early AVN can feel like a small hip strain. Many patients ignore it or take painkillers for weeks. Some are told it is muscle pain, back pain or general weakness.
The problem is that X-rays can look normal in very early AVN. MRI is usually needed to detect early-stage disease.
This is why persistent groin pain should not be ignored, especially if there is a history of steroid use, heavy alcohol use, trauma or previous severe illness.
Early Signs of Hip AVN
Watch for these signs:
- Deep pain in the groin or front of the hip
- Pain while walking or standing
- Pain that improves with rest but returns with activity
- Difficulty sitting cross-legged
- Difficulty wearing socks or shoes
- Limping while walking
- Pain at night or while changing position
- Pain after steroid use
- Hip stiffness without clear injury
In early AVN, the pain may come and go. That does not mean the condition is gone.
Who Is More at Risk?
AVN can happen due to several reasons:
- Long-term or high-dose steroid use
- Heavy alcohol consumption
- Hip fracture or dislocation
- Sickle cell disease
- Autoimmune conditions
- Previous COVID-related steroid treatment
- Blood clotting disorders
- Unknown causes in some patients
Patients between 30 and 50 can develop AVN, which makes early diagnosis even more important because preserving the natural hip joint may still be possible in selected cases.
Stage 1: MRI Shows AVN But X-ray May Be Normal
This is the earliest stage. The bone has started losing blood supply but the hip ball has not collapsed.
Treatment may include protected weight-bearing, medicines, lifestyle changes and sometimes core decompression depending on lesion size and patient factors.
The goal is to reduce pressure inside the bone and support new blood flow before collapse.
Stage 2: X-ray Changes Begin But Hip Shape Is Preserved
At this stage, X-rays may show changes in the femoral head but the ball has not collapsed.
Joint-preserving surgery like core decompression with bone grafting or biologic support may still be considered in selected patients.
The success of treatment depends on the size, location and stage of AVN.
Stage 3: Early Collapse
This is the turning point. The ball of the hip begins to lose its round shape. Pain usually becomes more frequent.
At this stage, joint-preserving treatment becomes less predictable. Some patients may still be considered for salvage options, but many begin discussing hip replacement if pain and function are significantly affected.
Stage 4: Collapse With Arthritis
At this stage, the hip joint surface is damaged and arthritis develops. Hip replacement usually becomes the more reliable treatment when pain affects walking, sleep and daily activity.
Modern hip replacement for AVN can give strong functional improvement, but the exact outcome depends on age, bone quality, muscle condition and overall health.
Treatment Options for AVN of Hip
1. Observation and Lifestyle Changes
In very small early lesions, the surgeon may monitor with repeat imaging. Patients may be advised to reduce weight-bearing, stop alcohol, avoid smoking and control medical risk factors.
2. Medicines
Some medicines may be used to support bone health or reduce progression risk in selected cases. These should only be taken under medical supervision.
3. Core Decompression
Core decompression involves making a channel into the affected bone to reduce internal pressure and encourage blood flow. AAOS describes core decompression as an option that can help prevent progression in some cases depending on stage and lesion size.
4. Bone Grafting or Biologic Support
In selected patients, core decompression may be combined with bone grafting or biologic material. This depends on surgeon judgment and MRI findings.
5. Hip Replacement
When the femoral head has collapsed or arthritis is established, hip replacement may be recommended.
When Should You See a Doctor?
You should consult an orthopaedic specialist if:
- Hip or groin pain lasts more than 3–4 weeks
- Pain increases with walking
- You have a history of steroid use
- You are limping
- You cannot sit cross-legged like before
- X-ray is normal but pain continues
- Pain is affecting sleep or work
AVN is not something to self-diagnose or wait out for months.
FAQ
The first symptom is often deep groin pain that increases with walking or standing.
Early AVN may not show on X-ray. MRI is more sensitive for early diagnosis.
In early stages, selected patients may be treated with joint-preserving options like core decompression. Late-stage AVN often needs hip replacement.
Steroid use is a known risk factor for AVN, especially high-dose or prolonged use.
Not always, but many cases can worsen if not detected and managed early. Regular follow-up is important.
Hip replacement is usually considered when the hip ball collapses, arthritis develops or pain significantly affects daily life.
Ready to Take the Next Step?
Dr. Utsav has experience in both joint preservation and hip replacement. That matters because early AVN needs a surgeon who can evaluate preservation options rather than jumping directly to replacement.
Call: +91 7447799000
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