Avascular Necrosis of the Hip: Symptoms, Causes and Treatment

Avascular necrosis is the death of bone tissue that happens when its blood supply is reduced or cut off. It is also called osteonecrosis, and while it can affect different bones, it often involves the hip, where it damages the femoral head, the ball at the top of the thighbone. Without a steady blood supply, the bone weakens and can eventually collapse, leading to hip pain and, over time, arthritis. Finding it early matters because more can be done to protect the joint before the bone collapses.

If you have ongoing hip or groin pain, getting the right diagnosis early matters. The board-certified and fellowship-trained hip specialists at Resurgens Orthopaedics diagnose and treat avascular necrosis of the hip at locations across metro Atlanta.

What Is Avascular Necrosis of the Hip?

The hip is a ball-and-socket joint, where the femoral head, the ball at the top of the thighbone, fits into a socket in the pelvis. Like all living bone, the femoral head needs a constant blood supply to stay healthy. In avascular necrosis, the blood flow is disrupted, and without it, the bone tissue begins to die. As the bone weakens, tiny breaks can form, and in time, the rounded surface of the femoral head can flatten or collapse. Once the smooth shape of the joint is lost, the cartilage wears down and arthritis develops. The disease most commonly affects the hip joint, though it can also affect other joints, such as the shoulder or knee.

What Causes Avascular Necrosis?

Avascular necrosis develops when something interrupts the blood supply to the bone. The causes generally fall into two groups. The first is a past hip injury that damaged the blood vessels supplying the femoral head. The second is a range of other causes, where blood flow is reduced without an injury. Common contributors include:

Corticosteroid Use: Long-term use of high-dose corticosteroid medication
Heavy Alcohol Use: Drinking heavily over many years
Previous Hip Injury: A past hip fracture or dislocation
Medical Conditions: Certain conditions, including blood disorders such as sickle cell disease
Circulation Problems: Other factors that affect blood flow, such as blood-clotting problems

In some cases, no clear cause is found. The condition is most common in people between the ages of 30 and 50, and some of its risk factors, such as steroid use and heavy alcohol use, can be addressed as part of treatment.

Avascular Necrosis Symptoms

In its earliest stage, avascular necrosis often causes no symptoms at all, which is part of why early diagnosis can be difficult. As it progresses, the most common symptoms include:

Gradual Hip or Groin Pain: Pain that develops slowly and worsens over time
Spreading Pain: Pain that can extend to the thigh, buttock or knee
Pain With Activity: Pain that is worse with weight-bearing and eases with rest
Limping: A growing limp or difficulty walking
Stiffness: A reduced range of motion in the hip

Please Note: The main concern with avascular necrosis of the hip is the health of the joint, so the goal of care is to relieve pain and protect the hip. Because the condition can be silent early on and offers more treatment options when caught early, it is worth having ongoing hip or groin pain evaluated by a specialist.

How Avascular Necrosis Is Diagnosed

A hip specialist starts with a physical examination and your medical history, paying attention to risk factors like steroid use, alcohol use or a past hip injury. Imaging confirms the diagnosis and shows how far it has progressed. An X-ray can reveal changes in more advanced disease, but it often looks normal in the early stages. An MRI can detect avascular necrosis earlier, before the bone collapses, which is why it is often used when the condition is suspected.

Avascular Necrosis Treatment

Treatment depends mainly on the stage of the disease, along with your age and overall health. The aim early on is to relieve pain, slow the damage and preserve your natural hip for as long as possible. Once the joint has collapsed, the focus shifts to restoring function, usually with joint replacement.

Nonsurgical and Joint-Preserving Treatment

When avascular necrosis is found before the femoral head collapses, the focus is on protecting the joint:

Activity Changes: Reducing stress on the hip while staying mobile
Medication: Anti-inflammatory medication to manage pain
Physical Therapy: Exercises to maintain motion and the strength of the surrounding muscles
Addressing Risk Factors: Reducing steroid use when possible or cutting back on alcohol
Core Decompression: A joint-preserving procedure that relieves pressure inside the bone and aims to improve blood flow, sometimes combined with a bone graft or regenerative techniques

Hip Replacement

When the femoral head has collapsed or significant arthritis has set in, a total hip replacement is a common way to relieve pain and restore function. The damaged ball and socket are replaced with smooth artificial components. Your Resurgens surgeon will discuss whether and when hip replacement is the right step for you, along with what recovery involves.

Schedule an Appointment for Hip Pain

If you have ongoing hip or groin pain, an early evaluation gives you the most treatment options. Book an appointment online today with Resurgens Orthopaedics or call us at (404) 847-9999.

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