Can AVN of the hip be cured without surgery?

In the earliest stages, joint-preserving procedures may halt progression and avoid replacement. Once the femoral head has collapsed, non-surgical treatment can help symptoms but cannot restore the joint surface. This is why early diagnosis matters.

Does AVN always lead to hip replacement?

Not always. Patients diagnosed before collapse may be candidates for joint-preserving surgery. Outcomes depend on the stage, extent of involvement and whether the underlying cause can be addressed.

Can steroids cause AVN?

Prolonged or high-dose steroid use is a recognised risk factor. Not everyone who takes steroids develops AVN, and the risk relates to dose and duration. If you develop hip pain after steroid treatment, mention the steroid history to your doctor.

Why is my X-ray normal if I have AVN?

Early AVN often does not show on X-ray. MRI detects changes considerably earlier, which is why it is recommended when symptoms and risk factors suggest AVN despite a normal X-ray.

Can AVN affect both hips?

Yes. A proportion of patients have involvement of both hips, sometimes with symptoms in only one. Both hips are usually imaged when AVN is diagnosed.

Is hip replacement suitable for younger AVN patients?

Younger patients are often more active, so implant positioning and component choice are particularly important. Joint preservation is considered first where the stage permits.

Avascular Necrosis (AVN) Hip Treatment in Mumbai

Introduction

Avascular necrosis of the hip occurs when the blood supply to the head of the thigh bone is reduced, causing the bone to weaken and, in later stages, collapse. It often affects younger adults, commonly between thirty and fifty, and unlike ordinary arthritis it can progress quickly if untreated.

Dr. Vaibhav Bagaria, Director of the Department of Orthopaedics at Sir H. N. Reliance Foundation Hospital, Mumbai, evaluates and treats hip AVN at all stages. Early diagnosis matters because treatment options in early AVN are entirely different from those available once the bone has collapsed.

What is avascular necrosis of the hip?

The femoral head — the ball at the top of the thigh bone — depends on a limited blood supply. When that supply is interrupted, areas of bone lose their nourishment and begin to die. Initially the bone may look normal on X-ray and the hip may feel normal too.

Over time, the weakened bone can no longer support load. The round shape of the femoral head may flatten and the joint surface can become irregular. Once that happens, arthritis follows.

AVN is described in stages. In the earliest stages the femoral head still holds its shape, and treatment can aim to preserve the joint. Once collapse has occurred, joint preservation is usually no longer possible and replacement becomes the reliable option.

Symptoms of hip AVN

✓ Groin pain, often the first symptom
✓ Pain that may extend to the thigh, buttock or knee
✓ Pain that worsens with walking, standing or climbing stairs
✓ Deep aching pain at rest or at night in later stages
✓ Progressive stiffness and reduced hip movement
✓ Difficulty sitting cross-legged, wearing socks or getting in and out of a car
✓ A limp as the condition advances
✓ In some cases, no symptoms at all in the earliest stage

What causes hip AVN?

1. Prolonged or high-dose steroid use

One of the most common causes. This includes steroids taken for inflammatory, autoimmune, respiratory or other conditions, including courses given during illness.

2. Alcohol intake

Sustained heavy alcohol consumption is a recognised risk factor.

3. Previous hip injury

Fracture or dislocation of the hip can damage the blood supply to the femoral head, sometimes causing AVN months or years later.

4. Sickle cell disease and other blood disorders

Conditions affecting blood flow or clotting can compromise the femoral head's circulation.

5. Radiation and chemotherapy

Treatment affecting the bone or its blood supply may contribute.

6. Idiopathic

In a proportion of cases no clear cause is identified.

Avascular necrosis of the hip illustration

When should you see a doctor?

Consult an orthopaedic surgeon if you have:

✓ Persistent groin pain, particularly if you are between thirty and fifty
✓ Hip pain following a course of steroids
✓ Pain that worsens with weight-bearing and improves with rest
✓ A previous hip fracture or dislocation with new hip pain
✓ Progressive stiffness or difficulty with cross-legged sitting
✓ Hip pain alongside sickle cell disease or an inflammatory condition on long-term steroids

AVN is worth investigating early. In the earliest stages it may not appear on an X-ray, and an MRI is the investigation that detects it. If your symptoms fit and your X-ray is normal, ask whether an MRI is appropriate.

When is hip pain an emergency?

Seek urgent attention for sudden inability to bear weight, severe pain after a fall or injury, obvious deformity or shortening of the leg, or hip pain with high fever.

How hip AVN is diagnosed

Medical history

Symptom onset and pattern, steroid history including short courses, alcohol intake, previous hip injury, sickle cell or other blood disorders, and current medication.

Physical examination

Hip range of movement, pain on rotation, walking pattern, leg length, and assessment of the other hip, as AVN affects both hips in a proportion of patients.

Imaging

X-rays of both hips are taken first, but can appear normal in early disease. MRI is the key investigation and detects AVN before X-ray changes appear. Staging from MRI determines which treatments are possible. A CT scan may be used in selected cases to assess collapse.

Hip AVN treatment in Mumbai

Treatment depends primarily on the stage — specifically, whether the femoral head has retained its shape.

Early-stage treatment — joint preservation

Where the femoral head has not collapsed, treatment aims to preserve the natural hip:

✓ Core decompression — reducing pressure within the femoral head to encourage blood flow, sometimes combined with bone graft or biological augmentation
✓ Orthobiologics — biological approaches to support bone healing in selected patients
✓ Protected weight-bearing — reducing load on the hip during treatment
✓ Managing the underlying cause — reviewing steroid use with the prescribing doctor where possible, and addressing alcohol intake
✓ Medication — where appropriate to the individual case

Advanced-stage treatment

Once the femoral head has collapsed and the joint surface is irregular, joint preservation is unlikely to succeed. Robotic hip replacement is the reliable option. AVN patients are often younger than typical hip replacement patients, which makes accurate component positioning particularly important for long-term function.

Related conditions treated

Hip arthritis

Hip impingement (FAI)

Hip fracture

Post-traumatic arthritis

About Dr. Vaibhav Bagaria

Dr. Vaibhav Bagaria is Director and Head of the Department of Orthopaedics at Sir H. N. Reliance Foundation Hospital, Mumbai, and one of the earliest surgeons in India to adopt robotic joint replacement. Over twenty-two years of practice he has treated patients across the full range of bone and joint conditions, with a particular focus on robotic knee and hip replacement, partial knee replacement, sports injury and arthroscopy, and complex pelvic and acetabular reconstruction.

Name

Dr. Vaibhav Bagaria

Experience

20+ Years

Qualifications

MS (Ortho) FASSI, FNUS, FNAMS..

Speciality

Specialist in Robotic Knee & Hip Replacement
Specialist in Sports Injury, Arthroscopy & Complex Trauma

Practice

President & National Delegate SICOT India
Director & Head Department of Orthopaedics — Sir H. N. Reliance Foundation Hospital, Mumbai

Dr. Vaibhav Bagaria, Director of Orthopaedics at Sir H. N. Reliance Foundation Hospital

Consultation

02261305757

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Avascular Necrosis (AVN) Hip
Treatment in Mumbai