Understanding Hip AVN
AVN may follow an injury or occur without any clear cause. Early disease may be visible on MRI even when X-rays appear completely normal — which is why timely assessment is so important.
Key principle: preserve the natural hip before collapse whenever possible; replace it only when collapse and arthritis make preservation unlikely to succeed.
Common Causes and Risk Factors
Steroid Use
Long-term or high-dose corticosteroid therapy.
Alcohol
Excessive alcohol consumption over time.
Injury
Hip fractures or dislocations that damage blood vessels.
Medical Conditions
Diabetes, autoimmune diseases and blood disorders.
Medical Treatments
Certain therapies may increase the risk of AVN.
Idiopathic AVN
In some patients, no clear cause is found.
Symptoms of Hip AVN
- Deep groin or hip pain
- Pain while walking or climbing stairs
- Limping or reduced walking distance
- Stiffness and reduced movement
- Night pain in advanced stages
Diagnosis
Evaluation includes a detailed medical history, clinical examination, X-rays, MRI and CT scans in selected cases.
MRI is the most sensitive test for early AVN and can detect disease before any changes are visible on X-rays.
Stage-Based Treatment of Hip AVN
Early AVN — Before Collapse
The aim is to preserve the natural hip and delay or prevent arthritis. Options include:
- Activity modification
- Pain-relieving medication
- Physiotherapy
- Protected weight bearing
- Core Decompression
- Core Decompression with PRP or BMAC in selected patients
Advanced AVN — After Collapse
When the femoral head has collapsed and arthritis has developed, Total Hip Replacement usually offers the most reliable pain relief and restoration of mobility. This involves:
- Removal of the damaged joint surfaces
- Modern hip implants for long-lasting function
- Structured rehabilitation
- Return to active, independent living for most patients
Core Decompression for Hip AVN
A joint-preserving procedure for Stage I and Stage II disease before collapse:
1 — MRI Planning
The affected area of the femoral head is precisely located.
2 — Small Channels
Specialised instruments create one or more channels into the femoral head.
3 — Pressure Reduction
Pressure inside the bone is reduced and new blood-vessel formation may be stimulated.
4 — Biological Support
PRP, BMAC or selected bone-forming cell therapies may support healing.
Read more: Core Decompression for Hip AVN →
Who is a Candidate for Hip Preservation?
Core Decompression is most effective in patients with:
- Stage I or Stage II Hip AVN
- Persistent hip or groin pain
- MRI-confirmed early disease
- No collapse of the femoral head
Once collapse has occurred, Total Hip Replacement usually becomes the more appropriate treatment.
Potential Benefits of Joint-Preserving Treatment
- Reduces pressure within the bone
- Reduces hip pain
- Encourages new blood-vessel formation
- Promotes bone healing
- Preserves the natural hip
- May postpone hip replacement
Advanced Regenerative Options
Platelet-Rich Plasma (PRP)
Growth-factor-rich plasma prepared from the patient's own blood to promote healing.
Bone Marrow Aspirate Concentrate (BMAC)
Concentrated bone marrow cells introduced into the decompressed area to support bone repair.
Cultured Osteoblasts
Selected patients may be considered for specialised bone-forming cell therapy to strengthen the femoral head.
Recovery
Core Decompression is usually performed through a small incision. Most patients can expect:
- A short hospital stay
- Early mobilisation with walking aids
- Gradual return to daily activities
- Physiotherapy to restore strength and mobility
Recovery is individualised according to the stage of AVN and the exact procedure performed.
Frequently Asked Questions (FAQs)
Can early AVN be treated without hip replacement?
Yes. Before collapse, treatment may include activity modification, protected weight bearing, physiotherapy, medication and Core Decompression, with or without biological augmentation.
When is hip replacement recommended?
When the femoral head has collapsed, arthritis has developed and pain or loss of mobility is significant.
Is Core Decompression successful?
It has the best chance of relieving pain and delaying progression when performed in Stage I or II disease, before collapse of the femoral head.
Will I definitely avoid hip replacement?
No procedure can guarantee this. Many patients delay replacement for years, but progression may still occur despite treatment.
Early Diagnosis Can Preserve Your Hip — a stage-based plan helps determine whether joint preservation or hip replacement is right for you.
If I need surgery, who will actually perform it?
Dr. Anand Jadhav performs every operation personally. Assisting staff may support the procedure, as is standard in any operating theatre, but the surgery itself is never delegated to another surgeon.