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Avascular Necrosis of the Hip
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Avascular necrosis of the hip, also called osteonecrosis, can cause pain and stiffness that affects daily life. Without treatment, the damaged bone can weaken and lead to collapse or arthritis.
At UT Southwestern Medical Center, our orthopedic specialists create personalized care plans for each patient. We offer nonsurgical and surgical treatments to relieve pain and preserve hip function whenever possible.
What Is Avascular Necrosis of the Hip?
Avascular necrosis (osteonecrosis) is a serious bone condition that occurs when blood flow to the bone slows or stops. It can occur in any bone, but it typically develops in the ends of long bones or in high-stress joints.
Avascular necrosis of the hip affects the ball-like part of the thigh bone, called the femoral head. Without enough blood, bone tissue can die. Over time, the weakened bone can collapse.
Dead bone tissue can damage the hip joint and lead to arthritis. Early diagnosis and treatment can help protect the hip joint.
Why Choose UT Southwestern for Avascular Necrosis of the Hip Care?
UT Southwestern’s orthopedic specialists provide comprehensive care for avascular necrosis of the hip. Our goal is to reduce pain, protect the hip joint, and help patients stay active.
Our team creates care plans based on each patient’s diagnosis, symptoms, and goals. When possible, we use treatments that help preserve the natural hip joint. If joint damage is severe, our surgeons can offer advanced hip treatment options.
Patients benefit from:
- Board-certified orthopedic specialists with deep experience treating hip conditions
- Leading-edge nonsurgical and surgical treatments
- Rehabilitation therapy to help with strength, movement, and recovery
- Access to hyperbaric oxygen therapy for certain patients
- Care at an academic medical center recognized for orthopedic expertise
What Are the Symptoms of Avascular Necrosis of the Hip?
Avascular necrosis of the hip may not cause symptoms at first. As it worsens, hip pain is often the first symptom. Pain may develop slowly over time, occurring in the:
- Hip
- Groin
- Thigh
- Buttocks
- Knee
At first, pain may happen only with standing or walking. Later, pain can occur during rest. The hip may also feel stiff or harder to move.
What Are the Risk Factors for Avascular Necrosis of the Hip?
Avascular necrosis of the hip is commonly linked to long-term or high-dose corticosteroid use. The exact reason is not known, but some researchers believe corticosteroids can raise lipid levels in the blood. This can lead to fatty deposits in blood vessels, which may reduce blood flow.
It can also be caused by a hip injury, such as a fracture, dislocation, or prior hip surgery. The injury can damage blood vessels, causing reduced blood flow to the femoral head.
Other risk factors include:
- Heavy alcohol use
- Smoking
- Sickle cell disease
- Lupus
- Gaucher disease, an inherited disorder that prevents the body from producing enough of an enzyme needed to break down lipids
- Blood clotting disorders
- High cholesterol or high blood lipids
- Decompression sickness (“the bends”), a pressure-related condition that can affect scuba and deep-sea divers
- Radiation therapy
- Chemotherapy
- Organ transplantation
- Certain infections or inflammatory conditions
In many cases, doctors cannot find one clear cause.
How Is Avascular Necrosis of the Hip Diagnosed?
UT Southwestern specialists begin by asking about the patient’s symptoms and medical history. They may also ask about hip injuries, steroid use, alcohol use, and other conditions.
During the exam, the doctor will move the hip in different ways to learn which movements cause pain. They may recommend imaging tests, such as:
- X-rays to check for bone collapse or joint damage
- Magnetic resonance imaging (MRI) to find early bone changes
- Computed tomography (CT) scan for detailed bone images
The doctor may also order blood tests to help identify an underlying cause.
How Is Avascular Necrosis of the Hip Treated?
Avascular necrosis of the hip can affect a person’s mobility and quality of life. Our specialists work with each patient to create a treatment plan that focuses on comfort, movement, and long-term hip health.
Treatment typically depends on the stage of the disease and the patient’s pain level, joint damage, and current health. The goal is to reduce pain and prevent further bone damage.
Nonsurgical Treatments
Early treatment may include nonsurgical options, such as:
- Rest
- Anti-inflammatory medicines or other medications
- Activity changes
- Crutches, a cane, or a walker
- Physical therapy
- Exercises to maintain hip motion
- Hyperbaric oxygen therapy, which involves breathing pure oxygen in a pressurized chamber to increase oxygen delivery to tissues
Doctors may also recommend reducing or stopping alcohol use or smoking. Some patients may need changes to steroid treatment, if medically safe.
Nonsurgical treatments may help symptoms, but they may not be able to stop the disease from getting worse.
Surgical Treatments
Surgery is often needed when the disease is more advanced. Surgical options include:
- Core decompression: The surgeon removes or drills into damaged bone to reduce pressure and improve blood flow. In some cases, bone marrow aspirate may be used with this procedure to help with new bone growth.
- Bone grafting: Healthy bone or synthetic material is transferred to the damaged bone, which may help new bone grow. In some cases, surgeons use a vascularized fibula graft, which uses bone from the lower leg along with its blood supply.
- Osteotomy: The surgeon cuts and realigns the bone to take pressure off the damaged area.
- Total hip replacement: Damaged bone and cartilage are replaced with an artificial joint (implant).
Core decompression is usually done before the femoral head collapses. Hip replacement is often used after collapse or if severe arthritis is present.
What Support Services for Avascular Necrosis of the Hip Does UT Southwestern Offer?
UT Southwestern offers a wide range of support services for patients receiving nonsurgical or surgical care for avascular necrosis of the hip. These services include:
- Physical therapy and rehabilitation programs
- Pain management
- Education to support recovery and long-term hip health
What Clinical Trials Are Available for Avascular Necrosis of the Hip?
UT Southwestern participates in research studies focused on improving care for people with avascular necrosis of the hip. Some patients may qualify for clinical trials that study new treatments or care approaches.
Ask our doctors about current studies or search for available clinical trials.
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