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Hip avascular necrosis treatment works best when it starts early, before the bone collapses. Avascular necrosis (also called osteonecrosis) means the blood supply to the ball of the hip joint has been cut off, so the bone begins to die. Caught early, several treatments can protect the joint and delay or prevent hip replacement. Once the bone collapses, hip replacement becomes the most reliable way to relieve pain and restore function. After more than twenty years focused on hip and knee surgery, here is how I walk patients through their choices.
What is avascular necrosis of the hip?
Avascular necrosis of the hip is bone death in the femoral head. The femoral head is the ball at the top of the thighbone. It dies when it loses its blood supply. Without a steady blood supply, the bone weakens and can flatten or collapse. When that happens, the smooth ball no longer glides in the socket, and arthritis and pain follow.
This condition tends to strike younger adults. Most patients I see are between 30 and 50, and it affects roughly 20,000 to 30,000 Americans each year. More than 6 in 10 patients have it in both hips, so I always check the other side even when only one hurts.
Common causes include long-term steroid use and heavy alcohol use, which together account for up to 90 percent of cases not caused by injury. Other triggers include hip fractures or dislocations, sickle cell disease, blood clotting disorders, and some cancer treatments. Sometimes no cause is found at all.
Early on, avascular necrosis can be silent. As it grows, most people feel a deep ache in the groin or hip. The pain gets worse with standing and walking, and it eases with rest. Many patients also notice a limp or stiffness. Because these signs look like ordinary hip strain, the diagnosis is often missed at first.
What are the main hip avascular necrosis treatment options?
Hip avascular necrosis treatment falls into three groups: medication and activity changes, joint-preserving surgery, and hip replacement. The right choice depends on the stage of the disease, whether the bone has collapsed, your age, and the underlying cause. Early disease has the most options; advanced disease usually points toward replacement.
Nonsurgical avascular necrosis treatment
Nonsurgical avascular necrosis treatment can ease pain, but it rarely stops the disease on its own. Options include anti-inflammatory medicine (NSAIDs) for pain, activity changes to take weight off the joint, and, in select cases, medicines that target bone turnover, cholesterol, or clotting.
Bisphosphonates and statins have shown mixed results in studies, so I use them selectively and only when the situation fits. For a hip that already hurts, medicine and rest control symptoms while we plan the next step. They do not reliably reverse the bone damage that has already happened.
Joint-preserving surgery
Joint-preserving surgery aims to save your own hip before the bone collapses. The most common option is core decompression, where a surgeon drills one or more small channels into the femoral head to relieve pressure and spark new blood vessel growth.
Done in early-stage disease, before the surface caves in, core decompression protects the joint in up to 90 percent of the earliest cases in some studies. Surgeons often add bone graft, and newer approaches add bone marrow cells or platelet-rich plasma to support healing. For select younger patients, a vascularised bone graft or a bone-reshaping osteotomy can buy years before replacement. These procedures are specialized, so when a patient is a candidate, I make sure they are evaluated by the right surgeon for that specific technique.
Hip avascular necrosis treatment once the bone has collapsed
Once the femoral head has collapsed, hip replacement is the most dependable option. Total hip replacement removes the dead, damaged bone and cartilage and replaces the ball and socket with durable implants. For advanced avascular necrosis, it is the most reliable way to end pain and restore walking, and modern implants last many years.
Because avascular necrosis often affects younger, active people, I plan each replacement carefully. I frequently use the Mako® robotic-assisted platform to position the implant precisely, which supports better fit and alignment. (I serve as a consultant for Stryker, the maker of the Mako system.) Results after hip replacement for avascular necrosis are very good, though the surgery can be slightly more demanding than a routine arthritis replacement.
Most patients walk the same day and return to normal activities over the following weeks. The goal is simple: end the pain and get you moving again on a hip you can trust.
Why does timing matter so much in hip avascular necrosis treatment?
Timing decides which treatment options you actually have. Joint-preserving surgery only works before the femoral head collapses. Once collapse happens, those options close, and replacement becomes the path forward.
Left untreated, most symptomatic hips go on to collapse. Research shows collapse in more than 85 percent of hips that hurt, and about two-thirds of hips that are not yet causing pain. That is why an early diagnosis is the single most valuable thing you can do for your hip.
How is avascular necrosis of the hip diagnosed?
Avascular necrosis of the hip is diagnosed with imaging, and MRI is the most accurate test. In early disease, X-rays often look normal, which is why patients can be told nothing is wrong for months. An MRI can detect the problem within days of the blood supply being cut off and is close to 99 percent accurate.
Ask about avascular necrosis if you have deep groin pain that worsens with weight and eases with rest. This is even more important with a history of steroids, heavy alcohol use, or a past hip injury. Naming the concern out loud often speeds up the right test.
When is avascular necrosis treatment surgery needed?
Avascular necrosis treatment surgery is needed when the disease progresses despite medication, or when imaging shows the bone is at high risk of collapse or has already collapsed. Small, early lesions that cause no symptoms are sometimes watched closely with repeat imaging. Larger lesions, or any sign of the surface flattening, usually call for surgery, either a joint-preserving procedure or a replacement, depending on the stage.
What to do next
Here is what I tell my patients: an early evaluation gives you the most control over your options. At the Bone and Joint Institute of Tennessee in Franklin, I care for patients across Middle Tennessee, including Nashville, Brentwood, Spring Hill, Columbia, and Nolensville.
If you have unexplained hip or groin pain, or a known risk factor, come in for an evaluation and imaging. The sooner we know the stage, the more we can do to protect your hip.
Ready to talk about your hip? Schedule an appointment with Dr. Calendine or call (615) 791-2630.
This article is for educational purposes only and does not replace personalised medical advice. Avascular necrosis is a progressive condition, and the right treatment depends on your individual health. Always consult a qualified orthopaedic surgeon before making treatment decisions. Individual results vary.
References
- Liu N, Zheng C, Wang Q, Huang Z. Treatment of non-traumatic avascular necrosis of the femoral head (Review). Exp Ther Med. 2022;23(5):321.
- Expert Panel on Musculoskeletal Imaging; Ha AS, Chang EY, Bartolotta RJ, et al. ACR Appropriateness Criteria Osteonecrosis: 2022 Update. J Am Coll Radiol. 2022;19(11S):S409-S416.
- Ando W, Sakai T, Fukushima W, et al. Japanese Orthopaedic Association 2019 Guidelines for osteonecrosis of the femoral head. J Orthop Sci. 2021;26(1):46-68.
- Moya-Angeler J, Gianakos AL, Villa JC, Ni A, Lane JM. Current concepts on osteonecrosis of the femoral head. World J Orthop. 2015;6(8):590-601.
- Mont MA, Zywiel MG, Marker DR, McGrath MS, Delanois RE. The natural history of untreated asymptomatic osteonecrosis of the femoral head: a systematic literature review. J Bone Joint Surg Am. 2010;92(12):2165-2170.
- Novriansyah R, Kesoema TA, Tjandra KC, et al. Assessing the latest advances in bone marrow stem cell therapy for avascular necrosis hip: a systematic review, meta-analysis, and meta-regression of randomized controlled trials. PLoS One. 2025;20(6):e0297319.
