Avascular Necrosis of the Hip: Symptoms, Stages and Treatment

Hip pain with no clear injury, that comes and goes and doesn't fit the usual pattern of simple arthritis, is sometimes something else entirely: avascular necrosis, a condition where the bone itself is losing its blood supply. Catching it early changes the treatment options significantly, which is exactly why understanding the warning signs matters.

What is avascular necrosis of the hip?

Also called osteonecrosis, avascular necrosis (AVN) occurs when blood flow to the ball of the hip joint, the femoral head, is disrupted. Bone is living tissue that needs a constant blood supply; without it, the affected bone weakens and, if the condition progresses, the femoral head can collapse, leading to joint damage and arthritis.

What causes avascular necrosis

• Long-term or high-dose steroid use, for conditions ranging from autoimmune disease to severe COVID-19 treatment courses
• Heavy alcohol use over a sustained period
• Hip injury or dislocation, which can directly damage the blood vessels supplying the femoral head
• Certain blood and medical conditions that affect clotting or blood flow
• No identifiable cause in a meaningful proportion of cases (called idiopathic AVN)

Symptoms

• Groin pain that comes and goes early on, often worse with weight-bearing
• Pain that may radiate to the buttock or thigh
• A limp developing as pain increases
• Stiffness and reduced range of motion as the condition progresses
• Pain at rest or at night in more advanced stages

Because early AVN can look normal on a plain X-ray, it is often missed or mistaken for a muscle strain until it progresses — an MRI is far more sensitive at this stage and is usually how the diagnosis is actually confirmed.

How avascular necrosis progresses

Treatment options

Treatment depends heavily on the stage at diagnosis. In early stages, before collapse has occurred, options include reducing weight-bearing on the joint, addressing the underlying cause where possible (such as stopping an avoidable steroid or reducing alcohol intake under medical guidance), and in selected patients, a surgical procedure called core decompression, which relieves pressure inside the bone and may improve blood flow. Once significant collapse and arthritis have developed, these joint-preserving options are far less reliable, and total hip replacement becomes the most predictable way to relieve pain and restore function. Our broader guide on hip pain and when hip replacement is needed covers that decision and the procedure itself in more depth.

Why early diagnosis matters so much here

Unlike common wear-and-tear hip arthritis, avascular necrosis can progress from mild, intermittent pain to joint collapse over months rather than years, particularly in stage II and III. This is why persistent or unusual groin pain — especially in someone with a relevant risk factor like steroid use — deserves an MRI rather than being dismissed as a muscle strain.

For an independent overview, see the American Academy of Orthopaedic Surgeons guide to osteonecrosis of the hip.

Practical Considerations for Avascular Necrosis

Who is at higher risk, and why screening the other hip matters

We most often see avascular necrosis in patients who have had a prolonged course of steroid medication for an unrelated condition, those with a significant alcohol history, and occasionally younger patients after a hip injury or dislocation. Because the same risk factor usually affects both hips at once, the opposite side is checked even when only one hip is painful — catching early changes there, before symptoms even start, is exactly the situation where joint-preserving treatment has the best chance of working.

What a diagnostic work-up actually involves

• A detailed history focused on steroid use, alcohol intake, and any past hip injury
• Examination of hip range of motion and pain pattern
• X-rays of both hips, which can look completely normal in early stages
• An MRI, which is far more sensitive and is usually what actually confirms early avascular necrosis

Living with early-stage AVN while being monitored

If you're diagnosed at an early stage, your surgeon may recommend reduced weight-bearing on the joint and closer monitoring with repeat imaging, rather than surgery immediately. Low-impact activity, maintaining a healthy weight, and strictly avoiding the original cause where possible (such as an avoidable steroid course) give the joint-preserving options their best chance of working before any collapse occurs.

Questions worth asking your surgeon

What stage is my hip at right now, on MRI rather than just X-ray? Is core decompression a realistic option for me, or has the window for that passed? Does my other hip need to be checked and monitored too? Clear answers to these shape a genuinely individualised plan rather than a one-size-fits-all approach to a condition that behaves very differently stage to stage.

If hip replacement becomes necessary

When AVN has progressed to collapse and arthritis, hip replacement in a younger patient works just as reliably as it does for age-related arthritis, though your surgeon will discuss implant choice and activity expectations with your longer remaining lifespan in mind, since the replacement may eventually need a revision decades later. This is a normal, well-planned part of care for AVN reaching this stage, not a sign that anything was missed earlier.

Reducing your risk if you're on long-term steroids

If a long-term steroid course is medically necessary for another condition, it usually cannot simply be stopped, but your treating doctors can take steps to use the lowest effective dose for the shortest reasonable duration, and can flag you for monitoring if AVN risk factors apply. Mentioning any new or unusual hip or groin discomfort to your doctor promptly, rather than assuming it's unrelated, gives the best chance of catching avascular necrosis at its most treatable stage.

Common questions before and after diagnosis

Is avascular necrosis the same as osteoporosis? No — osteoporosis is a generalised weakening of bone density throughout the skeleton, while AVN is a localised loss of blood supply to a specific area of bone, most often the femoral head. Can I keep exercising with early AVN? Low-impact activity is generally encouraged, while high-impact loading on the affected hip is usually restricted until your surgeon confirms it's safe, based on the stage. How often is it monitored? Early-stage AVN is typically followed with repeat imaging at intervals your surgeon sets, so that any progression toward collapse is caught early rather than discovered only once symptoms worsen. Does this mean I'll definitely need a hip replacement eventually? Not necessarily — patients diagnosed and managed at an early stage, before collapse occurs, have a real chance of avoiding or significantly delaying joint replacement.

Hip care in Wakad, Pune

Dr. Nirmal Patil, MS (Ortho), has 16 years of experience in hip and joint surgery at Precision Ortho Spine & Rehab Clinic in Wakad, Pune, treating patients from Hinjewadi, Baner, Pimple Saudagar, Ravet and across Pimpri-Chinchwad. If you have unexplained hip or groin pain, particularly with a history of steroid use or a previous hip injury, it's worth getting it properly investigated rather than waiting to see if it settles.