What is the incidence of avascular necrosis (AVN) of the hip in individuals in their late 20s?

How Rare is AVN of the Hip in Late 20s?

Avascular necrosis of the hip in individuals in their late 20s is uncommon in the general population, but the actual incidence depends heavily on the presence of specific risk factors—particularly corticosteroid use, alcohol abuse, sickle cell disease, and HIV infection.

Population-Level Incidence Data

The general population incidence provides important context for understanding baseline risk:

• Overall detection rates for symptomatic AVMs (not AVN) in population studies show rates of 1.1-2.1 per 100,000 population, though this data relates to arteriovenous malformations rather than avascular necrosis 1
• No specific population-based incidence data exists for AVN in the late 20s age group in the general medical literature reviewed
• AVN is characteristically diagnosed before age 40 years in most cases, making the late 20s within the typical age range for presentation 2

Risk-Stratified Incidence

The likelihood of AVN in your late 20s varies dramatically based on risk factor exposure:

High-Risk Populations (Substantially Elevated Risk)

• Corticosteroid therapy is the leading iatrogenic cause, with risk increasing with cumulative dose and duration 2, 3
• Chronic alcohol abuse represents a major independent risk factor for bilateral AVN 3
• Sickle cell disease is particularly important in younger patients, including those in their 20s 3
• HIV infection increases AVN risk independent of treatment, with approximately 5% of HIV patients having asymptomatic disease detectable on MRI 4, 3
• Kidney transplant recipients on high-dose glucocorticoids show at least 1.5-fold greater risk compared to low-dose regimens 1, 3

Additional Risk Factors

• Chemotherapy and radiation therapy 2, 3
• Hemoglobinopathies and hypercoagulability states 2, 3
• Hyperlipidemia 2, 3
• Blood dyscrasias including lymphoma and leukemia 3
• Gaucher disease and caisson disease 4, 3

Clinical Presentation Patterns

Understanding how AVN presents in this age group is critical:

• Pain is the cardinal symptom that prompts medical attention, characteristically increasing with activity and weight-bearing 4
• Early-stage disease can be asymptomatic, with positive MRI findings in approximately 5% of at-risk patients 2, 4
• Bilateral involvement occurs in 70-80% of nontraumatic cases, distinguishing it from traumatic AVN 3

Diagnostic Considerations

When AVN is suspected in someone in their late 20s:

• MRI without IV contrast is the gold standard with sensitivity and specificity approaching 100% 4
• A meta-analysis showed 93% sensitivity and 91% specificity for early detection 4
• Plain radiographs should be obtained first but have limited sensitivity in early disease 4
• If radiographs are normal but clinical suspicion remains high, proceed directly to MRI 4

Key Clinical Pitfalls

• Do not assume AVN is rare in young patients with significant risk factors (corticosteroids, alcohol, sickle cell disease, HIV) 2, 3
• Always evaluate both hips even when symptoms are unilateral, as bilateral involvement is the rule in nontraumatic cases 3
• Early diagnosis is critical because symptoms indicate disease is already underway, and joint-preserving interventions are only effective before subchondral collapse 2, 4

Bottom Line for Late 20s Population

While population-wide incidence data specific to the late 20s is not available, AVN in this age group should be considered uncommon but not rare, particularly in the presence of major risk factors. The condition falls well within the typical age range for AVN diagnosis (before age 40), and young patients with corticosteroid exposure, alcohol abuse, sickle cell disease, or HIV infection face substantially elevated risk compared to the general population 2, 3.