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Avascular Necrosis Hip Treatment in Mumbai by Dr. Mayur Rabhadiya

Understanding Avascular Necrosis of the Hip

Avascular necrosis of the hip is a condition in which part of the femoral head loses an adequate blood supply.

The femoral head is the ball at the upper end of the thigh bone. It fits into the acetabulum, or hip socket, to form the hip joint.

When blood flow is impaired, bone cells within the affected area may die. The weakened bone beneath the joint cartilage can then lose its structural support and gradually collapse.

Avascular necrosis is also called:

  • AVN of the hip

  • Osteonecrosis of the femoral head

  • Aseptic necrosis

  • Ischaemic necrosis of bone

Dr. Mayur Rabhadiya assesses AVN according to the cause, symptoms, MRI findings, size and location of the affected area, and whether the femoral head has already begun to collapse.

The distinction between pre-collapse AVN and post-collapse AVN is central to treatment selection.

How AVN Differs From Hip Osteoarthritis

AVN and hip osteoarthritis can both cause groin pain, stiffness and difficulty walking, but they begin differently.

In osteoarthritis, the primary problem is progressive degeneration of the joint cartilage and surrounding joint structures.

In AVN, the initial problem is impaired blood supply within the femoral head. Bone beneath the cartilage weakens and may collapse. Secondary osteoarthritis can then develop after the joint surface loses its normal shape.

This distinction matters because an early, structurally preserved femoral head may be considered for a hip-preserving procedure. Once collapse and advanced arthritis have occurred, joint-preserving treatment is much less predictable.

Patients with degenerative hip arthritis rather than AVN can read about hip arthritis treatment in Mumbai.

Symptoms of AVN of the Hip

Early AVN may cause no symptoms.

When symptoms develop, they may include:

  • Groin pain

  • Buttock pain

  • Pain in the front of the thigh

  • Pain extending toward the knee

  • Pain while standing or walking

  • Limping

  • Difficulty climbing stairs

  • Pain when entering or leaving a vehicle

  • Reduced hip movement

  • Pain at rest

  • Night pain in more advanced disease

Some patients have considerable pain while hip movement remains relatively preserved during the earlier stages.

As femoral-head collapse and secondary arthritis develop, stiffness and restriction of movement commonly become more apparent.

Symptoms may develop gradually over months, but the rate of progression varies between patients.

Causes and Risk Factors

AVN may occur after an injury or without a major traumatic event.

Recognised risk factors include:

  • Previous hip dislocation

  • Femoral-neck fracture

  • Prolonged or high-dose corticosteroid exposure

  • Heavy or prolonged alcohol consumption

  • Sickle cell disease

  • Systemic lupus erythematosus

  • Blood-clotting disorders

  • Some blood and bone-marrow conditions

  • Decompression sickness

  • Previous radiotherapy

  • Organ transplantation

  • Certain metabolic or inflammatory diseases

In some patients, no definite cause is identified. This is described as idiopathic AVN.

A risk factor does not prove that it caused the disease in an individual patient. Assessment should consider the complete medical history.

Patients using corticosteroids must not stop them abruptly without instructions from the prescribing physician.

Can AVN Affect Both Hips?

Yes. Non-traumatic AVN may affect both femoral heads, even when symptoms initially occur on only one side.

When AVN is confirmed in one hip, the opposite hip may require clinical assessment and, in selected cases, MRI evaluation.

The absence of pain does not always exclude early disease in the other hip.

Treatment decisions should still be made separately for each side because:

  • The stage may differ

  • The lesion size may differ

  • One side may have collapsed while the other remains intact

  • Symptoms and functional limitation may not be equal

Bilateral disease does not automatically mean that both hips require the same treatment at the same time.

Why Early Diagnosis Matters

Before collapse, the femoral head retains its overall shape.

This creates a potential window in which selected patients may be considered for procedures intended to preserve the natural hip.

After collapse:

  • The ball may become flattened

  • The joint surface may become irregular

  • Cartilage may deteriorate

  • The hip socket may develop secondary arthritis

  • Pain and stiffness may progress

A hip-preserving procedure cannot reliably restore a femoral head that has already undergone major structural collapse.

Early diagnosis does not guarantee successful joint preservation, but it allows a broader range of treatment options to be considered.

Clinical Assessment

Assessment begins with the symptom and medical history.

Important questions include:

  • Where is the pain felt?

  • When did it begin?

  • Is walking restricted?

  • Does pain occur at rest or at night?

  • Has there been a previous hip injury?

  • Has the patient used corticosteroids?

  • Is there a history of heavy alcohol consumption?

  • Are autoimmune, blood or clotting disorders present?

  • Has treatment for cancer or transplantation been required?

  • Is the opposite hip painful?

  • Have previous scans already shown AVN?

Examination may assess:

  • Walking pattern

  • Hip rotation

  • Hip flexion and extension

  • Pain during weight-bearing

  • Limb length

  • Muscle strength

  • Knee and lumbar spine findings

  • Dependence on a walking aid

The clinical findings should be correlated with appropriate imaging.

X-Rays and MRI for AVN

Hip X-rays

X-rays can help identify:

  • Sclerosis or increased bone density

  • Cystic changes

  • A crescent sign beneath the joint surface

  • Flattening of the femoral head

  • Structural collapse

  • Secondary joint-space narrowing

  • Arthritis involving the hip socket

Early AVN may not be visible on a routine X-ray.

MRI

MRI is the most useful imaging investigation when early AVN is suspected.

It can help identify:

  • Disease before changes appear on X-ray

  • The location of the necrotic area

  • The approximate size of the lesion

  • Bone-marrow changes

  • Early structural compromise

  • Involvement of the opposite hip

MRI findings must still be interpreted alongside symptoms and examination.

A positive MRI does not by itself determine whether core decompression, observation or hip replacement is appropriate.

Understanding AVN Stages

Several classification systems are used for femoral-head osteonecrosis. Although terminology varies, the practical treatment distinction is often simplified as follows.

Early or pre-collapse AVN

  • MRI shows osteonecrosis

  • X-rays may be normal or show early changes

  • The femoral head remains structurally intact

  • There is no significant flattening or collapse

Hip-preserving treatment may be considered in selected patients.

Early collapse

  • A subchondral fracture or crescent sign may be present

  • The joint surface may begin losing its shape

  • The amount of collapse may still be limited

The probability of preserving the natural hip is lower and depends on the extent and location of damage.

Advanced collapse and secondary arthritis

  • The femoral head is flattened or deformed

  • Joint congruity is lost

  • Cartilage damage and socket arthritis may develop

  • Pain, stiffness and disability are often substantial

Total hip replacement is commonly the more reliable treatment when symptoms justify surgery.

Non-Surgical Management of AVN

Non-surgical treatment may help control symptoms or reduce load on the affected hip.

It may include:

  • Activity modification

  • A walking stick or crutches

  • Temporary protected weight-bearing

  • Medically appropriate pain relief

  • Physiotherapy for strength and safe mobility

  • Management of relevant medical risk factors

  • Reduction or avoidance of alcohol

  • Review of corticosteroid exposure with the prescribing physician

  • Clinical and imaging follow-up

These measures do not reliably restore the blood supply or prevent collapse in every patient.

Protected weight-bearing may reduce pain and mechanical stress temporarily, but remaining on crutches indefinitely is not a dependable cure for AVN.

Treatment must balance symptom relief, muscle preservation and the risk of structural progression.

Medicines for AVN

Pain medicines may help a patient remain mobile while investigations and treatment planning are completed.

Medication selection depends on:

  • Kidney function

  • Stomach-ulcer risk

  • Cardiovascular health

  • Liver function

  • Blood-thinning medicines

  • Other medical conditions

No routinely prescribed pain medicine has been established as reliably reversing femoral-head osteonecrosis.

Various medicines have been studied for AVN, including drugs affecting bone turnover, fat metabolism or blood clotting. Evidence remains inconsistent, and these treatments are not universally appropriate.

Medication should not delay surgical assessment when imaging shows structural deterioration or symptoms are progressing.

Core Decompression for AVN

Core decompression is a hip-preserving operation that may be considered in selected patients before substantial femoral-head collapse.

During the procedure, one larger channel or several smaller channels are created through the femoral neck into the affected area.

The aims may include:

  • Reducing pressure within the bone

  • Creating pathways toward the affected region

  • Encouraging a healing response

  • Attempting to reduce the risk of further collapse

Core decompression is not suitable for every patient with AVN.

The likelihood of success is influenced by:

  • Disease stage

  • Size of the lesion

  • Location of the lesion

  • Presence of a subchondral fracture

  • Existing collapse

  • Underlying medical cause

  • Continued steroid or alcohol exposure

  • Patient age and general health

The procedure offers the greatest potential before collapse, but it cannot guarantee preservation of the natural hip.

Bone Grafting and Biological Augmentation

Core decompression may sometimes be combined with:

  • Bone graft

  • Synthetic bone substitute

  • Bone-marrow aspirate concentrate

  • Cellular preparations

  • Other biological augmentation methods

These techniques aim to support the affected area or improve the biological environment.

However, preparation methods and clinical evidence vary.

No graft, stem-cell preparation or biological injection can be promised to:

  • Regrow a normal femoral head

  • Reverse established collapse

  • Guarantee that hip replacement will never be required

  • Work equally well across all stages of AVN

Patients should understand whether the proposed augmentation is established, investigational or supported only by limited evidence.

The cost of an added biological procedure should also be weighed against the realistic probability of benefit.

Can PRP or GFC Treat AVN?

PRP and GFC are platelet-derived injections primarily discussed for symptom management in selected arthritic conditions.

They should not be promoted as established standalone treatments for femoral-head AVN.

Current evidence does not establish that an intra-articular PRP or GFC injection can reliably:

  • Restore blood supply to the femoral head

  • Replace dead bone

  • Prevent structural collapse

  • Reverse a crescent sign

  • Reconstruct a collapsed joint surface

An injection into the hip joint is also different from a surgical procedure directed into the necrotic bone.

Temporary pain improvement, if it occurs, does not prove that the AVN has healed.

Treatment After Femoral-Head Collapse

Once meaningful collapse has occurred, the success of core decompression becomes substantially less predictable.

Treatment depends on:

  • Extent of collapse

  • Secondary arthritis

  • Pain severity

  • Hip movement

  • Walking limitation

  • Patient age

  • General medical health

  • Functional goals

A patient with limited collapse and manageable symptoms may still be monitored or considered for a specialised preservation procedure in selected circumstances.

When collapse is advanced and associated with substantial pain and functional loss, total hip replacement is usually the more reliable reconstructive option.

Hip Replacement for AVN

Total hip replacement replaces the damaged femoral head and the diseased hip socket with artificial components.

It may be considered when AVN has caused:

  • Femoral-head collapse

  • Secondary hip arthritis

  • Persistent groin pain

  • Night or resting pain

  • Severe walking restriction

  • Significant stiffness

  • Loss of independence

  • Failure of appropriate non-surgical care

The decision is not based on MRI findings alone.

The expected benefits, surgical risks, implant considerations and rehabilitation requirements should be discussed individually.

Patients can read the complete guide to total hip replacement in Mumbai after that page has been revised.

The main surgical overview is available on the hip replacement surgeon in Mumbai page.

When Should Treatment Be Reassessed?

Reassessment is advisable when:

  • Groin pain is worsening

  • Walking distance is declining

  • A limp is becoming more prominent

  • Pain occurs regularly at rest or at night

  • Hip movement is being lost

  • The patient requires stronger pain medicines

  • The opposite hip develops symptoms

  • Follow-up imaging suggests progression

  • Core decompression has not controlled symptoms

  • Daily independence is being lost

Repeated symptom treatment should not replace structural reassessment when AVN is known to be present.

Patients uncertain about the transition to replacement can read when hip replacement is needed after publication.

Frequently Asked Questions About AVN of the Hip

What is AVN of the hip?

AVN is loss of healthy bone caused by impaired blood supply to part of the femoral head.

Is AVN the same as hip arthritis?

No. AVN begins within the bone. Advanced AVN can later cause collapse and secondary hip arthritis.

What are the early symptoms?

Early disease may be painless. When symptoms develop, groin, buttock or thigh pain is common.

Can AVN cause knee pain?

Yes. Pain from the hip can be referred toward the thigh or knee.

Can an X-ray miss early AVN?

Yes. Early-stage disease may not be visible on routine X-rays.

Is MRI necessary?

MRI is commonly used when early AVN is suspected or when X-rays do not explain the symptoms.

Can AVN affect both hips?

Yes. Non-traumatic AVN may be present in both hips, even when only one side is initially painful.

Is steroid use associated with AVN?

Prolonged or high-dose corticosteroid exposure is a recognised risk factor, but not every steroid user develops AVN.

Should I stop steroid medicines?

No prescribed steroid should be stopped abruptly without instructions from the treating physician.

Is alcohol associated with AVN?

Heavy or prolonged alcohol consumption is a recognised risk factor. Reduction or cessation should be discussed as part of treatment.

Can AVN heal without surgery?

Some small or early lesions may remain stable, but spontaneous recovery cannot be assumed. Progression risk depends on the stage, size and location of the lesion.

Does reduced weight-bearing cure AVN?

It may reduce pain and stress temporarily, but it does not reliably prevent collapse on its own.

What is core decompression?

Core decompression is a hip-preserving operation that creates one or more channels into the affected femoral head.

When does core decompression work best?

It is most often considered before substantial collapse, especially when the lesion size and location remain suitable.

Can core decompression guarantee that replacement will be avoided?

No. Some hips still progress and later require replacement.

Can stem cells reverse AVN?

Cell-based augmentation remains variable and cannot be promised to reconstruct a normal femoral head or reverse established collapse.

Can GFC or PRP cure AVN?

Current evidence does not establish GFC or PRP injection as a reliable treatment for restoring blood supply or preventing femoral-head collapse.

When is hip replacement required for AVN?

Replacement may be considered after collapse when pain and functional limitation are substantial and joint-preserving treatment is unlikely to provide sufficient benefit.

About Dr. Mayur Rabhadiya

Dr. Mayur Rabhadiya is an Orthopedic & Joint Replacement Surgeon in Mumbai.

His qualifications include:

  • MBBS from LTMMC & GH, Sion Hospital

  • D’Ortho from KMC, Hubli

  • DNB Orthopedics from the National Board of Examinations, New Delhi

  • MNAMS Orthopedics

  • Fellowship in Robotic & Computer-Navigated Joint Replacement

His approach to avascular necrosis is stage-specific and evidence-based.

Early AVN is assessed for the possibility of preserving the natural hip, while advanced collapse is evaluated according to pain, function, secondary arthritis and suitability for hip replacement.

No injection, graft or biological treatment is presented as a guaranteed method of reversing AVN or preventing future surgery.

Last medically reviewed: June 2026.

Book an AVN Hip Consultation in Mumbai

Patients with diagnosed or suspected AVN, unexplained groin pain, steroid exposure, femoral-head collapse or a previous recommendation for hip surgery can consult Dr. Mayur Rabhadiya at Ghatkopar East or Ghatkopar West, Mumbai.

Call +91 84249 03913 or +91 96113 30063.

Appointments can also be requested through the orthopedic doctor consultation page.

Medical References

This patient-education page is informed by current educational and clinical evidence from:

  • American Academy of Orthopaedic Surgeons

  • National Library of Medicine

  • Peer-reviewed research concerning osteonecrosis of the femoral head

Medical Disclaimer

This information is intended for general patient education and does not replace clinical examination, MRI interpretation or personalised surgical advice.

AVN treatment depends on the underlying cause, disease stage, lesion size and location, presence of femoral-head collapse, symptoms, medical conditions and patient goals. Seek prompt assessment for rapidly worsening pain, inability to bear weight, fever or severe symptoms after an injury.

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