Avascular Necrosis

Avascular Necrosis (AVN)—also called osteonecrosis—occurs when reduced blood supply leads to bone death within a joint, most commonly the hip. Without treatment, the bone weakens, the joint surface can collapse, and early arthritis develops.

At The New Foscote Hospital, patients have rapid access to consultant orthopaedic assessment, on-site MRI, and a full range of joint-preserving and joint-replacing surgeries tailored to the stage of disease.

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Symptoms

AVN often develops gradually. Typical features include:

• Deep groin pain (hip AVN), sometimes felt in the buttock or thigh
• Pain on weight-bearing and with rotation of the joint
• Night pain or rest pain as disease progresses
• Stiffness, reduced range of movement and a limp
• Catching or giving way if the joint surface starts to collapse

While the hip is most commonly affected, knee, shoulder and ankle involvement can occur.

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Who Is At Risk?

Factors that increase risk of AVN include:

• Previous injury (fracture or dislocation around the joint)
• Corticosteroid use (especially long-term/high dose)
• Excess alcohol intake
• Blood and clotting disorders (e.g. sickle cell disease, thrombophilia)
• Autoimmune conditions (e.g. lupus)
• Radiation or certain chemotherapy agents
• Idiopathic (no clear cause)

Early diagnosis is key to preserving the joint.

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Diagnosis At The New Foscote Hospital

Your consultant will examine the joint and arrange appropriate imaging:

• X-ray – may be normal in early disease; shows stage and collapse later
• MRI – the most sensitive test to detect early AVN and assess extent
• CT ( at sister hospital) – in selected cases to evaluate subchondral collapse and surgical planning

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Treatment Options

Management depends on stage, joint involved, symptoms and activity level. Your surgeon will discuss the most suitable approach:

Non-Operative Care (Early or Low-Grade Disease)

• Activity modification and protected weight-bearing
• Analgesia/anti-inflammatories and targeted physiotherapy
• Risk factor optimisation (e.g. steroid review, alcohol reduction)

Note: Medications such as bisphosphonates may be considered in selected cases; evidence and suitability vary.

Joint-Preserving Surgery (Pre-collapse or Early Collapse)

• Core Decompression (± biologic adjuncts): relieves intra-osseous pressure and stimulates revascularisation in early AVN.
• Bone Grafting (structural or vascularised grafts): supports the diseased area and may delay or prevent joint collapse.
• Osteotomy (selected cases): redirects load away from the necrotic segment.

Joint Replacement (Established Collapse/Arthritis)

• Total Hip Replacement (THR) or resurfacing (carefully selected patients): restores function and relieves pain when the joint surface has failed.
• Shoulder/Knee/Ankle Reconstruction as indicated for other joints.

Your consultant will explain expected outcomes, recovery timelines and rehabilitation plans for each option.

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Rehabilitation And Recovery

Post-procedure recovery is supported by individualised physiotherapy, focusing on:

• Protected weight-bearing and gait retraining
• Range of movement and strength restoration
• Return to activity guidance and joint protection strategies

We provide clear advice on return to work, driving and sport based on surgical findings and your goals.

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When To Seek Specialist Help

Book an assessment if you have:

• Persistent groin or joint pain impacting daily life
• Pain after a previous fracture/dislocation around a joint
• Risk factors (e.g. long-term steroids) with new joint symptoms
• Imaging that suggests early AVN and you want joint-preserving options

Early referral improves the chance of joint preservation.