Overview
Osteonecrosis, also known as avascular necrosis (AVN), occurs when there is a loss of blood supply to an area of bone, causing the bone tissue to weaken and eventually collapse. The hip is the most commonly affected joint, particularly the femoral head (the ball of the hip joint).
Without treatment, osteonecrosis can lead to progressive joint damage, arthritis, and increasing pain and disability. Early diagnosis and intervention are important, as treatment is often more successful before the bone begins to collapse.
At London Bridge Orthopaedics (LBO), our hip specialists provide rapid access to expert assessment, advanced imaging, and comprehensive treatment options, ranging from conservative management to joint-preserving surgery and hip replacement.
Anatomy
The hip is a ball-and-socket joint, where the rounded femoral head fits into the socket of the pelvis (acetabulum). The femoral head relies on a delicate network of blood vessels for its nourishment.
If this blood supply becomes disrupted, the bone cells begin to die, causing the bone to weaken. Over time, the smooth joint surface may collapse, leading to arthritis and increasing pain and stiffness.
Causes and Risk Factors
The exact cause of osteonecrosis is not always clear, but several factors increase the risk:
- Previous hip injury or fracture
- Long-term steroid use
- Excessive alcohol consumption
- Certain medical conditions, including autoimmune diseases and blood disorders
- Previous chemotherapy or radiotherapy
- Decompression sickness
- Smoking
- Occasionally, no identifiable cause (idiopathic AVN)
Symptoms
Symptoms often develop gradually and may include:
- Deep pain in the groin, buttock, or thigh
- Pain that worsens with walking, standing, or exercise
- Stiffness and reduced hip movement
- Difficulty putting on shoes and socks
- Limping
- Pain at night or when resting in more advanced cases
Diagnosis
Early diagnosis is essential because standard X-rays may appear normal in the early stages.
At London Bridge Orthopaedics, we offer a one-stop diagnostic pathway, including:
Your consultant will discuss your symptoms, medical history, and examine your hip movement and gait.
Imaging
- X-rays to assess joint damage
- MRI scans, which are highly sensitive for early osteonecrosis
- CT scans if further detail is required for surgical planning
Having access to on-site imaging means investigations can often be arranged quickly, allowing treatment decisions to be made without unnecessary delays.
Treatment Options
Non-Surgical Treatment
In the early stages, treatment may focus on slowing disease progression and managing symptoms.
Treatment options may include:
- Activity modification
- Temporary reduction in weight-bearing
- Physiotherapy
- Pain relief and anti-inflammatory medication
- Addressing underlying risk factors
However, once structural damage develops, surgery is often required.
Surgical Treatment
Core Decompression
For early-stage AVN, surgery may involve creating small channels within the bone to reduce pressure and stimulate new blood vessel formation.
Potential benefits include:
- Pain reduction
- Improved function
- Delaying or preventing joint collapse
- Potentially avoiding hip replacement
Results are generally best when performed before collapse of the femoral head occurs.
Bone Grafting Procedures
In selected cases, bone grafting techniques may help support weakened bone and encourage healing.
Total Hip Replacement
When significant collapse or arthritis has developed, a total hip replacement often provides the most reliable solution.
Modern hip replacements have excellent outcomes, with most patients experiencing:
- Significant pain relief
- Improved mobility
- Return to everyday activities
- Long-lasting improvements in quality of life
How London Bridge Orthopaedics Can Help
At London Bridge Orthopaedics, our experienced hip surgeons work closely with our wider multidisciplinary team (MDT), including specialist physiotherapists and musculoskeletal radiologists.
Our one-stop service provides:
- Rapid specialist assessment
- On-site X-ray and MRI investigations
- Access to expert physiotherapy
- Individualised treatment plans
- Advanced hip preservation and replacement surgery
- Comprehensive rehabilitation programmes
Frequently Asked Questions
Is osteonecrosis the same as arthritis?
No. Osteonecrosis is caused by loss of blood supply to bone. However, it can eventually lead to secondary arthritis if left untreated.
Can osteonecrosis heal by itself?
Unfortunately, it rarely heals completely on its own. Early diagnosis and treatment can help slow progression and preserve the joint.
Will I need a hip replacement?
Not necessarily. Early-stage disease may be suitable for joint-preserving procedures. Hip replacement is generally reserved for advanced cases.
Can I continue exercising?
Low-impact activities are usually encouraged, although high-impact exercise may need to be modified depending on the severity of the condition.
What is the long-term outlook?
Many patients do very well, particularly when diagnosed early. Modern surgical treatments can provide excellent pain relief and restore mobility.
