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Osteonecrosis of the hip

Overview | Cause | Symptoms | Treatment


Osteonecrosis of the hip (avascular necrosis of the hip) is a painful condition that occurs when the blood supply to the bone is disrupted. It can ultimately lead to destruction of your hip joint.


Osteonecrosis of the hip develops when the blood supply to the femoral head is disrupted. Without adequate nourishment, the bone in the head of the femur dies and gradually collapses. As a result, the articular cartilage covering the hip bones also collapses, leading to disabling arthritis.

Although it is not always known what causes the lack of blood supply, there are a number of risk factors that can make it more likely for someone to develop the disease:

  • Injury — Hip dislocations, hip fractures, and other injuries can damage the blood vessels and impair circulation to the femoral head
  • Alcoholism
  • Corticosteroid medicines — Many diseases, such as asthma, rheumatoid arthritis, and systemic lupus erythematosus, are treated with steroid medications, which is linked to the disease
  • Other medical conditions — Osteonecrosis is associated with other diseases, including Caisson disease (diver's disease or "the bends"), sickle cell disease, myeloproliferative disorders, Gaucher's disease, systemic lupus erythematosus, Crohn's disease, arterial embolism, thrombosis, and vasculitis

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Like osteoarthritis, the most common symptom is pain around the hip joint. The pain typically develops slowly and worsens over time, although sudden onset is also possible. 

Pain and stiffness may be worse in the morning, or after sitting or resting for a while. Over time, painful symptoms may occur more frequently, including during rest or at night. Additional symptoms may include:

  • Pain in your groin or thigh that radiates to your buttocks or your knee
  • Pain that flares up with vigorous activity
  • Stiffness in the hip joint that makes it difficult to walk or bend
  • "Locking" or "sticking" of the joint, and a grinding noise during movement
  • Decreased range of motion in the hip that affects the ability to walk and may cause a limp
  • Increased joint pain with rainy weather

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We specialize in early surgical management of osteonecrosis that attempts to prevent a total joint replacement. We use several techniques and always strive for the least invasive procedure.

Nonsurgical Treatment

Lifestyle modifications: Some changes in your daily life can protect your hip joint and slow the progress of osteoarthritis.

  • Minimizing activities that aggravate the condition
  • Switching from high-impact activities (like jogging or tennis) to lower impact activities (like swimming or cycling) 
  • Losing weight

Physical therapy: Specific exercises can help increase range of motion and flexibility, as well as strengthen the muscles in your hip and leg.

Assistive devices: Using walking supports like a cane, crutches, or a walker can improve mobility and independence.

Medications: If your pain affects your daily routine, or is not relieved by other nonsurgical methods, your doctor may add medication to your treatment plan.

Surgical Treatment

Your doctor may recommend surgery if your pain from osteonecrosis causes disability and is not relieved with nonsurgical treatment.

Core decompression: Your doctor will drill a precise hole or several small holes into the femoral head to relieve pressure and allow access for new blood vessels to grow in.

Osteotomy: Your doctor will make precise cuts in the femur to better align the hip.

Total hip replacement: Your doctor will remove both the damaged acetabulum and femoral head, and then position new metal, plastic or ceramic joint surfaces to restore the function of your hip. Learn more about the procedure.

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