Avascular Necrosis of the Femoral Head — What You Need to Know

What Is Avascular Necrosis?

The blood supply to the femoral head is interrupted. Without blood, the bone gradually dies, weakens, and collapses. The earlier it is discovered, the more treatment options are available.

What Causes It?

Prolonged corticosteroid therapy — the most common risk factor.

Chronic alcohol consumption — the second most common cause.

Femoral neck fractures.

Autoimmune diseases — lupus and others requiring corticosteroids.

Idiopathic — about 20% of cases have no identified cause.

Stages (Ficat Classification)

Stage I — Normal X-ray. Diagnosis is made by MRI. Offers the most therapeutic options.

Stage II — Visible changes on X-ray, without collapse.

Stage III — Collapse of the femoral head. The surface becomes deformed.

Stage IV — Joint destruction. Replacement surgery becomes necessary.

Early Diagnosis — The Key to Success

An MRI is essential — it can detect necrosis months before changes appear on an X-ray. If you have risk factors and hip pain, request an MRI.

Treatment

Early Stages (I-II): Reducing weight-bearing, eliminating the risk factor, monitoring with serial MRIs.

Advanced Stages (III-IV): Hip replacement — the standard treatment. In cases with large bone defects, loss of bone stock or complex sequelae, reconstructive surgery is required.

The key message: early diagnosis makes the difference between conservative treatment and a replacement.

For context, see the dedicated page on hip replacement, and if you want to go deeper, read aboutthe complete guide to hip osteoarthritis and aboutthe causes of hip pain.

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