Avascular necrosis (AVN) — also called osteonecrosis — is death of bone tissue from disrupted blood supply. When it affects the femoral head (the ball of the hip), it can lead to hip collapse and severe arthritis if not caught early.
Common causes and risk factors
- Long-term or high-dose corticosteroid use
- Heavy alcohol use
- Prior hip trauma (fracture, dislocation)
- Sickle cell disease and other blood disorders
- Certain autoimmune conditions
- Radiation or chemotherapy
- Sometimes no clear cause (idiopathic)
How it presents
- Gradual onset of groin or hip pain, sometimes referring to the thigh or knee
- Pain with weight-bearing, better with rest (early stages)
- Progressive pain even at rest as the disease advances
- Reduced hip range of motion
- Limping
Why early recognition matters
AVN progresses through stages. Caught early — before femoral head collapse — there are joint-preserving surgical options with good outcomes. Once the femoral head collapses, hip replacement becomes the typical endpoint.
Diagnosis
Early AVN is often invisible on X-ray. If symptoms and history suggest AVN, MRI is the gold standard — it shows changes long before X-ray does. Anyone with unexplained hip pain and AVN risk factors should have MRI early.
Our role
Chiropractors don't treat the underlying bone disease of AVN — that's an orthopedic issue. But we do:
- Recognize the pattern and refer promptly
- Manage compensatory soft tissue and gait issues
- Coordinate with your medical team
- Provide pain modulation and mobility support in early and post-surgical phases
Red flags for immediate referral
- Progressive hip pain with no clear injury history
- Presence of significant AVN risk factors (long-term steroids, heavy alcohol use, sickle cell disease)
- Symptoms not fitting a typical mechanical pattern
If you have persistent unexplained hip pain, especially with risk factors, come in for an assessment. Early recognition is one of the most important things we do.