From the Guidelines
Avascular necrosis of the hip typically presents with progressive pain in the groin, buttock, or thigh that worsens with weight-bearing and activity. Early symptoms may be mild and intermittent, often occurring only during physical activity, but gradually become more constant and severe as the condition progresses. Patients may experience limited range of motion in the affected hip, particularly with internal rotation, and may develop a limp to compensate for the pain. Some individuals report pain at night or when resting. As the condition advances, patients may have difficulty walking without assistance and experience pain even at rest. The symptoms typically worsen over time as the femoral head collapses due to bone death from inadequate blood supply. This collapse occurs because without proper blood flow, bone tissue dies and eventually breaks down, leading to joint destruction. Risk factors include corticosteroid use, excessive alcohol consumption, trauma, and certain medical conditions like sickle cell disease. Early diagnosis is crucial as treatment options are more effective before significant bone collapse occurs, so anyone experiencing persistent hip pain should seek medical evaluation promptly, as supported by the most recent guidelines 1.
Key Symptoms
- Progressive pain in the groin, buttock, or thigh
- Pain worsens with weight-bearing and activity
- Limited range of motion in the affected hip
- Limping to compensate for the pain
- Pain at night or when resting
- Difficulty walking without assistance
Importance of Early Diagnosis
Early diagnosis of avascular necrosis is important to exclude other causes of patient’s pain and to allow for possible early surgical prevention to prevent articular collapse and the need for joint replacements, as highlighted in the 2022 update of the ACR Appropriateness Criteria for osteonecrosis 1. Imaging, particularly magnetic resonance imaging (MRI), is crucial for diagnosis and preoperative planning.
Risk Factors
Risk factors for osteonecrosis are numerous and include trauma, corticosteroid therapy, alcohol use, HIV, lymphoma/leukemia, blood dyscrasias, chemotherapy, radiation therapy, Gaucher disease, and Caisson disease, as outlined in the evidence 1. Understanding these risk factors can help in the early identification and management of individuals at higher risk of developing avascular necrosis of the hip.
From the Research
Symptoms of Avascular Necrosis of the Hip
The symptoms of avascular necrosis of the hip can vary, but common symptoms include:
- Pain in the hip or groin area, which can be mild or severe 2, 3, 4
- Limited mobility or stiffness in the hip joint 3, 4
- Pain that worsens with activity and improves with rest 3, 4
- Difficulty walking or bearing weight on the affected hip 2, 4
Progression of Symptoms
As the disease progresses, symptoms can worsen and may include:
- Increased pain and stiffness in the hip joint 2, 3, 4
- Decreased mobility and range of motion in the hip joint 3, 4
- Eventual collapse of the bone, leading to degenerative arthritis 2, 3, 4
Treatment and Management
Treatment for avascular necrosis of the hip often focuses on managing pain and preventing further damage to the bone and joint. This can include:
- Medications, such as bisphosphonates, to reduce pain and slow disease progression 2, 3, 4
- Physical therapy to maintain mobility and range of motion in the hip joint 3, 4
- Surgery, such as total hip replacement, in advanced cases where the bone has collapsed or the joint is severely damaged 2, 3, 4
Pathophysiology of Avascular Necrosis
Avascular necrosis is a complex disease caused by a lack of blood supply to the affected bone, which can be due to various factors, including: