Avascular Necrosis of the Hip

Avascular necrosis (AVN) of the hip is a serious orthopedic condition that occurs when the blood supply to the femoral head is disrupted. If left untreated, it can lead to permanent joint damage. Since the disease often causes no symptoms in its early stages, diagnosis can be challenging. However, in later stages, it typically presents with groin pain, limited range of motion, and a significant decline in quality of life.

When diagnosed early, avascular necrosis can often be treated effectively with intraosseous bioplasty—a minimally invasive and biologically supported surgical technique that removes dead bone tissue and stimulates healing before the femoral head collapses. This approach can significantly delay or even eliminate the need for joint replacement.

Raising awareness about risk factors and early warning signs is crucial for managing the disease before it progresses.

If you're experiencing persistent hip pain and suspect a serious condition like avascular necrosis, it is important to consult an orthopedic specialist for an accurate diagnosis and appropriate treatment. Dr. Utku Erdem Özer, an experienced orthopedic surgeon based in Istanbul, provides expert care for avascular necrosis and a wide range of hip disorders, combining knowledge, empathy, and years of clinical experience.

With the right treatment strategy, hip function can be preserved and quality of life significantly improved. To learn more about your treatment options, you can contact Dr. Utku Erdem Özer.

What Is Avascular Necrosis of the Hip?

The hip joint is one of the largest and strongest joints in the human body. It is composed of two main structures: the acetabulum (hip socket) and the femoral head (the ball-shaped top of the thigh bone that fits into the socket). Avascular necrosis of the hip is a condition that occurs when the blood supply to the femoral head is disrupted.

When the femoral head does not receive enough blood, the bone tissue becomes deprived of nutrients and begins to weaken, ultimately losing its structural integrity. This can lead to cracks in the cartilage and collapse of the underlying bone. Patients typically present with groin pain, limited mobility, and difficulty walking.

If not diagnosed and treated in the early stages, this condition can progress and cause irreversible damage to the hip joint. In advanced stages, the joint may become completely nonfunctional, making total hip replacement surgery the only viable treatment option.

However, with early diagnosis and appropriate treatment, the progression of avascular necrosis can be slowed or even halted, preserving hip function and maintaining a good quality of life.

If left untreated, avascular necrosis of the hip can lead to severe osteoarthritis. To learn more about treatment options for hip osteoarthritis, you can visit our Hip Osteoarthritis page.

What Causes Avascular Necrosis of the Hip?

Avascular necrosis develops when blood flow to the femoral head is reduced or completely blocked. Bone tissue needs a constant and adequate blood supply to remain healthy. When blood circulation is compromised, the bone weakens, collapses, and may crack under the cartilage surface.

The primary causes of avascular necrosis include:

Traumatic Causes:

• Femoral Head and Neck Fractures: Fractures around the hip joint can damage the blood vessels that supply the femoral head.

• Traumatic Hip Dislocation: Severe trauma can cause the hip to dislocate, potentially injuring the blood vessels in the process.

Blood Clotting Disorders:

• Many cases of avascular necrosis are believed to be related to underlying clotting abnormalities, even if patients show no outward signs. These conditions may impair blood flow to the femoral head.

Systemic Diseases:

• Sickle Cell Anemia: Abnormally shaped red blood cells can block blood vessels, reducing blood flow.

• Gaucher’s Disease: This genetic disorder causes fat buildup in the body, which can negatively affect blood flow to the bones.

• Certain Viral Infections: Some viruses can interfere with the circulatory system and reduce blood supply to the hip.

Medication and Hormonal Imbalances:

• Long-Term Corticosteroid Use: High doses of corticosteroids can weaken bones and interfere with their blood supply.

• Excess Cortisol Production: The body’s overproduction of cortisol can have similar effects on bone health.

Radiation Exposure:

• Cancer Treatments: Radiation therapy to the pelvic region can damage blood vessels and reduce circulation.

• Occupational Exposure: Certain professions that involve chronic radiation exposure may increase the risk.

Lifestyle Factors:

• Chronic Alcohol Use: Heavy and prolonged alcohol consumption can negatively affect bone health and circulation.

Avascular necrosis of the hip often results from a combination of these factors. In some cases, however, the exact cause remains unknown. People with known risk factors should have regular orthopedic evaluations to ensure early detection and timely treatment.

Who Is at Risk for Avascular Necrosis of the Hip?

Certain individuals are more likely to develop avascular necrosis due to underlying health conditions, trauma, medication use, or lifestyle habits. The main risk factors include:

Medical and Metabolic Conditions:

• Sickle Cell Anemia: Can block blood vessels, leading to impaired nutrition of the femoral head.

• Leukemia and Lymphoma: Some blood cancers can affect the bone marrow and circulatory system.

• Gaucher’s Disease: This genetic disorder can cause inadequate bone nourishment due to fat accumulation.

• Viral Infections: Certain viral illnesses may disrupt blood circulation and contribute to bone death.

• HIV Treatment: Protease inhibitors used in HIV therapy may increase the risk of avascular necrosis.

Trauma and Physical Stress:

• Hip Fractures: Breaks in the femoral head or neck can disrupt blood flow.

• Traumatic Hip Dislocation: Dislocation of the joint can damage blood vessels in the area.

• Deep-Sea Diving (Caisson Disease): Rapid pressure changes during professional diving can impair blood flow and lead to bone damage.

Radiation and Medication Use:

• Radiation Therapy: Treatments aimed at the pelvic area may reduce blood supply to the bones.

• Corticosteroid Use: Prolonged or high-dose use can damage bone structure and interfere with circulation.

• Excess Cortisol Production: Conditions that cause the body to produce too much cortisol also increase the risk.

Lifestyle Factors:

• Chronic Alcohol Consumption: Heavy drinking over time can reduce blood flow and weaken bone tissue.

What Are the Symptoms of Avascular Necrosis of the Hip?

Avascular necrosis (AVN) of the hip is a condition that results from the loss of blood flow to the femoral head, causing the bone tissue to die over time. In the early stages, AVN may not cause noticeable symptoms, making diagnosis more difficult. However, as the disease progresses, symptoms become more apparent and can significantly impact quality of life.

Pain

• Groin Pain: This is the most common symptom of hip AVN. The pain usually starts in the groin area and may radiate to the front of the thigh or even down toward the knee.

• Pain That Worsens with Activity: Activities like walking, climbing stairs, or lifting heavy objects may exacerbate the pain.

• Rest Pain in Advanced Stages: As the condition worsens, the pain may persist even during rest and can interfere with sleep at night.

Another common cause of hip pain is a labral tear. For more information, visit our Hip Labral Tear page.

Limited Range of Motion

• As the disease progresses, the range of motion in the hip joint gradually decreases.

• Difficulty Squatting or Rotating the Hip: Patients often report, “I can’t squat like I used to,” or “I have trouble rotating my hip to the side.”

• Everyday activities become more difficult, and overall quality of life declines.

Limping

• To reduce pain, patients may unknowingly alter their gait, resulting in a noticeable limp.

Bilateral Involvement

• Avascular necrosis of the hip is often bilateral. If it develops in one hip, there is approximately an 80% chance that the other hip will also be affected.

Early Diagnosis Is Crucial: The symptoms of hip AVN depend on the stage of the disease. If you notice pain, restricted movement, or limping, consult an orthopedic specialist as soon as possible to prevent further joint damage.

If you're experiencing hip pain with limited motion, our Hip Impingement Syndrome article may also be helpful.

Staging of Avascular Necrosis of the Hip

Avascular necrosis is classified into stages based on the progression of the disease and the extent of damage to the femoral head. Staging is essential for determining the most appropriate treatment plan.

In the early stages, non-surgical treatment methods may be effective. In contrast, advanced stages usually require surgical intervention.

Treatment Options for Avascular Necrosis of the Hip

Treatment for AVN of the hip depends on the stage of the disease and the degree of bone damage. Scientific studies have shown that certain medications used for osteoporosis may be beneficial in the early stages.

However, as the disease progresses, surgical treatment often becomes necessary to relieve pain and restore hip function.

Intraosseous Bioplasty in the Treatment of Avascular Necrosis of the Hip

Intraosseous bioplasty is an advanced, biologically supported surgical technique that has gained prominence in the treatment of avascular necrosis (AVN) of the hip in recent years. Unlike traditional core decompression, this method not only removes the dead bone tissue but also reinforces the area with biologically active materials that promote bone regeneration. This approach helps slow disease progression and preserve hip function.

How Is Intraosseous Bioplasty Performed?

• Surgical Technique: Through a small incision of approximately 1–2 cm, the surgeon gains access to the femoral head. A precise tunnel is created toward the necrotic area, and the nonviable bone tissue is carefully removed.

• Biological Augmentation: The cavity is filled with biologically active materials such as bone marrow concentrate or ACP PRP to stimulate new bone formation.

• Pain Relief: Decompressing the femoral head reduces internal pressure, alleviates edema, and significantly relieves pain.

• Improved Blood Flow: The tunnel and biological agents help restore local circulation, enhancing the body's natural healing response in the affected area.

When Is It Recommended?

Intraosseous bioplasty is especially effective in the early stages of avascular necrosis (Stages 1 and 2). MRI scans are used to precisely locate and assess the extent of the necrosis, allowing for accurate surgical planning.

Additional Biological Support Options:

• Bone Grafting: In some cases, bone graft harvested from the patient’s pelvis can be placed in the cleaned area to provide structural support.

• Stem Cell Therapy: Stem cells derived from the patient’s own bone marrow can be used to promote bone regeneration.

• ACP PRP (Autologous Conditioned Plasma): Platelet-rich plasma obtained from the patient’s own blood is injected into the area to accelerate healing and enhance cellular regeneration through concentrated growth factors.

The Goal of Treatment

The main goal of intraosseous bioplasty is to prevent the collapse of the femoral head and preserve the natural function of the hip joint. By addressing the condition early, the need for total hip replacement surgery can be delayed or potentially avoided altogether.

Successful treatment of avascular necrosis of the hip depends on early diagnosis, appropriate patient selection, and the use of biologically enhanced surgical techniques. The treatment plan should always be personalized based on the stage of the disease and the patient’s overall health status.

Does Exercise Help with Avascular Necrosis?

Exercise can be beneficial in certain stages of avascular necrosis (AVN), but this depends entirely on the stage of the disease and the advice of your orthopedic specialist. Physical therapy is often recommended to help maintain joint mobility and manage pain.

Benefits of Exercise:

• Helps preserve joint function

• Strengthens muscles to support the joint

• Reduces stiffness and improves range of motion

However, any activities that increase pain or place excessive stress on the hip joint should be avoided.

What Happens If Avascular Necrosis Is Left Untreated?

If left untreated, AVN can progress and lead to severe joint damage. Over time, the bone may collapse, causing chronic pain and significant loss of mobility. This greatly reduces a person’s quality of life.

Potential consequences of untreated AVN:

• Irreversible loss of joint function

• Need for major surgeries like total hip replacement

• Chronic pain and difficulty walking

Frequently Asked Questions (FAQs)

1. How is avascular necrosis of the hip diagnosed?

Hip AVN typically presents with groin pain, limited range of motion, and limping. In early stages, it may be asymptomatic and often discovered incidentally on MRI performed for other reasons. If your pain worsens with activity and persists at rest, consult an orthopedic specialist promptly.

2. What happens if avascular necrosis is not treated?

If left untreated, AVN can lead to collapse of the femoral head, severe structural damage in the hip joint, and significant loss of mobility. In advanced stages, pain can become unbearable and hip replacement surgery may be inevitable.

3. What is the recovery time after core decompression surgery?

Most patients can return to normal activities within 6 to 12 weeks after core decompression surgery. During the first 2 weeks, the use of crutches is recommended to avoid full weight-bearing on the hip. Recovery time can vary depending on the patient’s overall health and the stage of the disease.

4. Which age group is most commonly affected by hip AVN?

Avascular necrosis of the hip is most frequently seen in individuals between 30 and 60 years old. However, those with risk factors like corticosteroid use, heavy alcohol consumption, or genetic predisposition may develop it at a younger age.

5. Can avascular necrosis heal completely?

If diagnosed early and treated appropriately, the progression of the disease can be stopped and hip joint function can be largely preserved. In advanced stages, however, total hip replacement is usually required for long-term relief.

6. What non-surgical treatments are available for hip AVN?

In the early stages, non-surgical treatments such as medication, physical therapy, and activity modification may be effective. Additionally, regenerative therapies like stem cell treatment and ACP PRP (Autologous Conditioned Plasma)can support bone healing.

7. How can the pain caused by AVN be managed?

Pain management options include anti-inflammatory medications, physical therapy, and adjusting daily activities. Weight management and reducing stress on the hip joint can also help alleviate discomfort.

8. What imaging methods are used to diagnose AVN?

MRI is the preferred imaging modality, as it can detect early changes in the bone. X-rays and bone scans may be used in later stages to assess the extent of joint damage.

9. Can someone with AVN still play sports?

In early stages, low-impact activities such as swimming or water aerobics may be appropriate. High-impact sports and exercises that put excessive stress on the hip should be avoided. Always consult your orthopedic specialist for personalized guidance.

10. How long does it take to return to normal life after AVN surgery?

Recovery time depends on the individual and the type of surgery performed. Most patients return to daily activities within 3 to 6 months, but full recovery and restoration of joint function may take up to a year.

11. Is it possible to fully recover from avascular necrosis?

Yes, if diagnosed in the early stages and treated effectively, some patients achieve full recovery without the need for major surgery.

12. What helps improve AVN?

Rest, physical therapy, and appropriate surgical interventions can help slow disease progression and improve symptoms.

13. Is avascular necrosis a type of cancer?

No, AVN is not cancer. It is a condition related to disrupted blood supply to the bone, leading to bone tissue death.

14. How is avascular necrosis of the femoral head identified?

It is typically diagnosed through joint pain, restricted movement, and confirmed with advanced imaging techniques like MRI.

Conclusion

Avascular necrosis of the hip is a progressive orthopedic condition that often remains silent in its early stages but can lead to severe joint damage, pain, and disability if left untreated. Early diagnosis is essential to preserving hip function and preventing irreversible complications.

In early-stage AVN (Stages 1 and 2), intraosseous bioplasty offers a highly effective,

minimally invasive treatment option. By removing dead bone tissue and biologically stimulating healing, this procedure can halt disease progression, reduce pain, and maintain joint integrity, often eliminating or significantly delaying the need for more invasive interventions.

However, in advanced stages of the disease, when the femoral head has already collapsed and joint function is severely compromised, total hip replacement remains the most effective and permanent solution.

Each patient’s treatment plan should be tailored based on the stage of the disease, overall health, and lifestyle needs. Recognizing symptoms early and seeking timely orthopedic evaluation can dramatically improve outcomes.

If you're experiencing hip pain, limited motion, or limping, don't delay. Early intervention is the key to preserving your joint and quality of life.

Take the First Step Toward a Pain-Free Life

Early diagnosis and the right treatment plan are essential for a healthy, pain-free future. Protect your hip health and improve your quality of life by scheduling a consultation today.

For expert evaluation and treatment of hip avascular necrosis and other orthopedic conditions, contact Dr. Utku Erdem Özer, an experienced orthopedic surgeon in Istanbul.

To learn more, visit the Dr. Utku Erdem Özer page and take the first step toward better joint health.