Avascular Necrosis of the Hip

What is Avascular Necrosis of the Hip?

Avascular necrosis, also called osteonecrosis, is the death of bone cells in the head of the femur when their blood supply is interrupted. Without circulation the bone weakens, and over time the rounded femoral head can flatten and collapse. It most often affects adults under 50.

The causes range from hip trauma such as a fracture or dislocation, to long-term steroid use, heavy alcohol intake, sickle cell disease, and certain cancer treatments. In many cases no single cause is found.

Early on there may be no symptoms at all. This is why diagnosis is often delayed, and why timing matters so much. The earlier the stage at which we intervene, the better the chance of preserving the joint.

Symptoms

• Groin pain that is worse when bearing weight
• Pain that progresses to ache at rest as the condition advances
• Pain referred to the buttock, outer thigh, or knee
• Stiffness and a reducing range of hip movement
• A limp on the affected side
• Difficulty with stairs and prolonged standing

How We Treat It

In the early stages, before the femoral head has collapsed, our focus is on protecting the joint and supporting bone repair. PRP therapy concentrates your own platelets and growth factors and, delivered under image guidance into the affected zone, can stimulate healing in bone that still has the capacity to recover. We pair this with activity modification and load management so the weakened bone is not overstressed while it repairs.

Where pain is the dominant problem and the joint is irritable, an intra-articular injection under fluoroscopic or ultrasound guidance places medication precisely in the joint space to settle pain and keep you mobile. We are clear about the limits of these measures: advanced disease with collapse usually needs surgical assessment, and we will refer promptly when that point is reached rather than persist with injections that cannot help.