A dull ache in the groin. Pain that comes and goes at first, then stops going. Stiffness when getting out of a chair. These are the earliest warning signs of a condition that many patients ignore for months and sometimes years before they understand what is happening inside their hip.
Avascular Necrosis (AVN) of the hip, also called osteonecrosis, is a condition in which the blood supply to the femoral head (the ball of the hip joint) is interrupted. Without blood, bone tissue begins to die. If caught early, it can often be treated conservatively. If left untreated, the femoral head collapses, the joint is destroyed, and hip replacement becomes the only option.
Dr. Supreet Bajwa, a leading AVN and Hip Replacement Surgeon at Wockhardt Hospital Mumbai Central, sees patients at every stage of this condition and the outcome is almost always better when they come in earlier.
What Causes AVN of the Hip?
AVN occurs when blood flow to the femoral head is disrupted. Common causes include:
- Long-term steroid use - The most common cause in India, particularly in patients on steroids for kidney disease, asthma, or autoimmune conditions
- Alcohol misuse - Heavy alcohol use disrupts lipid metabolism and damages blood vessels
- Hip fracture or dislocation - Trauma can directly damage the blood vessels supplying the femoral head
- Sickle cell disease - Abnormal red blood cells block small vessels in bone
- Blood clotting disorders - Conditions that promote clotting can compromise blood flow
- Idiopathic - In some patients (especially younger ones), no clear cause is found
The Stages of AVN: Understanding the Progression
Orthopaedic surgeons classify AVN using the Ficat & Arlet / ARCO staging system:
Stage 1: Blood supply is interrupted, but the X-ray looks normal. Only an MRI can detect early-stage AVN. The femoral head is intact. This is the ideal time to intervene.
Stage 2: Early changes visible on X-ray. The bone is showing signs of stress, but the femoral head has not collapsed. Conservative or joint-preserving options are still viable.
Stage 3: The femoral head begins to flatten or "crescent" - a sign of early collapse. This is a critical turning point. Surgery is almost always required, but joint-preserving procedures may still be possible.
Stage 4: The femoral head has collapsed significantly. The joint cartilage is damaged. Arthritis sets in. Hip replacement is typically the only effective treatment.
Stage 5–6 (advanced): Complete collapse with severe joint space narrowing and secondary acetabular (socket) involvement. Hip replacement is necessary.
Warning Signs - Don't Ignore These
AVN is frequently misdiagnosed as a back problem or muscle strain in its early stages. Watch for:
- Groin pain - The most characteristic symptom. Not the outer hip — the deep groin crease.
- Pain with activity that initially improves with rest - In early stages
- Pain at rest and at night - In advanced stages
- Limping or favouring one leg
- Limited range of motion in the hip - Particularly internal rotation
- Pain in the thigh or knee - AVN can refer pain downward
If you are on long-term steroids, have had a hip injury, or have a condition that affects blood flow, you are in a higher-risk category. An MRI of the hip can detect AVN even when X-rays look completely normal.
Treatment Options by Stage
Early Stage (1–2): Joint-Preserving Treatment
- Core decompression - Small holes are drilled into the femoral head to reduce pressure and stimulate new blood vessel growth. Best results in Stage 1-2.
- Bone marrow-derived stem cell therapy - Combined with core decompression in some centres for enhanced biological healing
- Protected weight-bearing - Reducing load on the affected hip to slow progression
- Medications - Bisphosphonates and vasodilators may slow progression in early stages (evidence is still evolving)
Mid Stage (3): Joint-Preserving or Replacement
- Vascularised fibula graft - A specialised procedure transferring living bone with its blood supply into the femoral head. Technically demanding.
- Partial or total hip replacement - Depending on the extent of collapse
Late Stage (4 and beyond): Hip Replacement
Total hip replacement is the most reliable and durable treatment for advanced AVN. In younger patients (under 35), Dr. Bajwa carefully considers implant selection to maximise longevity.
Why Early Diagnosis Is the Difference
The single most important factor in AVN management is time. A Stage 1 or Stage 2 patient has real options options that preserve the natural hip joint. A Stage 4 patient needs a hip replacement.
If you or a family member have risk factors for AVN steroids, alcohol, sickle cell, previous hip fracture do not wait for pain to become severe. An MRI takes 30 minutes and can catch AVN years before the joint collapses.
Frequently Asked Questions
Can AVN be cured without surgery?
In Stage 1 and some Stage 2 cases, core decompression and protected weight-bearing can stabilise the condition. True reversal is rare. The goal is to slow or halt progression.
Is AVN common in India?
AVN is more prevalent in India than in Western countries, largely due to higher rates of steroid use for kidney disease, tuberculosis, and rheumatological conditions.
Which is better - core decompression or hip replacement for AVN?
It depends on the stage. Core decompression works best in Stage 1–2 before collapse. Once the femoral head has collapsed (Stage 3–4), hip replacement gives more predictable pain relief and function.
Can both hips be affected by AVN?
Yes bilateral AVN (both hips) occurs in approximately 50–80% of cases, particularly in steroid-induced and sickle cell-related AVN. Both hips should be evaluated even if only one is symptomatic.
How do I know if my groin pain is AVN?
Groin pain in someone with risk factors (steroids, alcohol, sickle cell, previous hip fracture) warrants an MRI, regardless of what an X-ray shows. MRI is the gold standard for early AVN detection.
Book a Consultation: For a transparent, no-pressure discussion about hip replacement costs and options in Mumbai, contact Dr. Supreet Bajwa at Wockhardt Hospital, Mumbai Central & Miraroad. Call or WhatsApp: +91 9820727046