AVN Avascular Necrosis (Osteonecrosis) in the Hip

What Is Avascular Necrosis (AVN)?

Avascular necrosis (AVN), most appropriately known as osteonecrosis, ischemic bone necrosis, or aseptic necrosis, is a serious orthopedic condition that occurs when bone tissue dies due to reduced or interrupted blood supply. Over time, this loss of circulation can lead to bone weakening, collapse, and severe joint pain. AVN most commonly affects the hip, but can also affect other joints like the knee or shoulder.

Dr. Prem Ramkumar, a board-certified orthopedic surgeon serving patients in Long Beach, Los Angeles, Orange County, Southern California and surrounding areas, specializes in the diagnosis and treatment of avascular necrosis. With advanced imaging techniques and personalized treatment options, Dr. Ramkumar helps patients restore mobility, reduce pain, and prevent joint deterioration caused by AVN.

What Causes Avascular Necrosis (AVN)?

Avascular necrosis is caused by an interruption of blood flow to the bone, leading to bone tissue death and joint damage. Common causes include:

• Traumatic injury, such as a fracture or dislocation
• Long-term corticosteroid use
• Excessive alcohol consumption
• Certain medical conditions like sickle cell disease, lupus, or diabetes.

In some cases, AVN can develop without a clear cause (idiopathic AVN). Dr. Prem Ramkumar, identifies the underlying cause of AVN to create a personalized treatment plan that helps preserve joint function and prevent bone collapse.

Who is at risks for developing avascular necrosis (AVN) in the hip?

Several factors can increase your risk of developing avascular necrosis of the hip, a condition that can lead to hip pain, stiffness, and joint collapse if left untreated. Common risk factors include:

• Traumatic hip injuries: fractures or dislocations that disrupt blood flow to the femoral head.
• Long-term corticosteroid use: medications that can affect circulation and bone health.
• Excessive alcohol consumption: prolonged alcohol use can damage blood vessels and bone tissue.
• Medical conditions: such as sickle cell disease, lupus, diabetes, and autoimmune disorders.
• Radiation or chemotherapy treatments which can weaken bone and affect vascular health.
• Blood clotting disorders that reduce blood flow to the hip joint.
• High cholesterol levels can block small blood vessels that nourish bone tissue.
• Genetic predisposition or idiopathic causes: AVN can sometimes develop without a known cause.

What are the symptoms of Hip AVN or Hip Avascular Necrosis?

The symptoms of avascular necrosis (AVN) in the hip often begin gradually and worsen over time as blood flow to the bone decreases. Early signs may include dull, aching pain in the hip, groin, or buttock, especially after physical activity or weight-bearing. As the condition progresses, patients may experience stiffness, limited range of motion, and pain while walking or standing. In advanced stages, hip collapse or arthritis may develop, causing severe, constant pain.

How is avascular necrosis (AVN) in the hip diagnosed?

Avascular necrosis (AVN) of the hip is diagnosed through a combination of clinical evaluation and advanced imaging studies. Dr. Ramkumar will review the your medical history, symptoms, and physical exam findings, followed by imaging tests such as X-rays, MRI scans, or CT scans to detect early bone changes and to assess the extent of damage. An MRI is especially effective in identifying AVN early, which is key to keeping the joint healthy.

What are the treatment options for AVN or avascular necrosis (Osteonecrosis) of the hip?

The treatment of avascular necrosis (AVN) in the hip depends on the stage of the condition, the amount of bone damage, and the patient’s activity level. Early diagnosis and personalized care from Dr. Prem Ramkumar, who specializes in AVN, can help slow progression, relieve pain, and preserve hip function, however early treatment is key.

Non-Surgical Treatment Options for AVN or Osteonecrosis in the Hip:

In the early stages of AVN, non-surgical treatments may help manage symptoms and protect the joint from further damage. These may include:

• Medications: Anti-inflammatory drugs (NSAIDs) to reduce pain and swelling or bisphosphonates may help slow bone loss.
• Activity modification: Limiting weight-bearing activities to reduce stress on the hip joint.
• Physical therapy: Targeted exercises to maintain flexibility and strengthen supporting muscles.
• Assistive devices: The use of crutches or canes to offload pressure from the affected hip.
• Biologic treatments: Emerging options such as stem cell therapy or platelet-rich plasma (PRP) injections to promote bone healing.

Surgical Treatment Options for Osteonecrosis or AVN in the Hip:

If AVN in the hip has progressed or if conservative treatments have failed to alleviate pain or are no longer effective, surgical intervention may be necessary to restore hip function and prevent collapse. Common surgical options include:

• Core decompression: A minimally invasive procedure that relieves bone pressure and stimulates new blood vessel growth. However, this does not have a high success rate beyond 1-2 years.
• Bone grafting: Replacing the damaged bone with healthy bone tissue to support healing. This also is unlikely to result in incorporation given the lack of blood supply.
• Osteotomy: Reshaping the bone to shift weight away from the damaged area.
• Cartilage transplant: For focal areas of AVN (known as osteochondritis dissecans), this can be a very helpful technique
• Hip resurfacing: Preserving more natural bone while restoring joint surface integrity.
• Total hip or knee replacement (arthroplasty): Recommended for advanced AVN when the bone has collapsed and joint preservation is no longer possible.

Dr. Prem Ramkumar is an experienced orthopedic hip surgeon serving Long Beach, Los Angeles, Orange County, and Southern California surrounding areas, offers both non-surgical and surgical treatment options for avascular necrosis. Using advanced imaging, minimally invasive techniques, and personalized rehabilitation plans, Dr. Ramkumar helps patients reduce pain, restore mobility, and return to an active lifestyle.