The first symptom is usually groin pain, at first with activity and later at rest as well. What matters most is early diagnosis: in early stages the radiograph can be normal, which is why MRI is essential — it detects the necrosis before the bone collapses.
Treatment depends on the stage. In early stages, before collapse, there are options to preserve the femoral head (such as core decompression, sometimes with grafting). Once the head has collapsed and arthritis is present, total hip replacement is the treatment that restores function.
Dr. Kushner’s approach: in osteonecrosis, time is joint. Detecting it on MRI before collapse opens the door to treatments that save the patient’s own hip.
When to seek care without waiting
- Pain that comes on suddenly and stops you bearing weight, especially after a stumble or a fall.
- Fever with a hot, swollen, very painful hip: joint infection must be ruled out.
- Night pain that does not settle at rest and worsens week after week.
- Unexplained weight loss, or a history of cancer.
- Numbness or tingling running down the leg, or weakness that is getting worse.
What it gets confused with
| Finding | Avascular necrosis | Hip osteoarthritis |
|---|---|---|
| Onset | Pain appearing over weeks, sometimes severe from the start | Slow progression over years |
| Typical age | Adults aged 30 to 55 | Usually after 55 |
| Initial radiograph | May be normal: MRI is needed | Changes visible early |
| Why it matters | Diagnosing it before collapse changes the options | Treatment is guided by symptoms |
Frequently asked questions
Why did I get this without an injury?
Necrosis can appear without trauma, associated with corticosteroids, alcohol or other causes — and sometimes with no identifiable cause.
Can the hip be saved?
Yes, if it is diagnosed early, before collapse. That is why persistent hip pain deserves investigation.
Can the hip be saved?
It depends above all on whether the femoral head has already collapsed. Before collapse there are procedures to preserve the joint; afterwards, reconstruction with a replacement is usually the reasonable option. That is why early diagnosis changes the prognosis.
My X-ray was normal but it still hurts.
That is typical in early stages. MRI detects necrosis much earlier than radiographs, and it is the indicated study when there is clinical suspicion.
Can it affect both hips?
Yes, bilateral involvement is common. When it is diagnosed on one side it is worth investigating the other, even if it does not hurt yet.
References
- Mont MA, et al. Nontraumatic osteonecrosis of the femoral head: where do we stand today? A 5-year update. J Bone Joint Surg Am. 2020;102(12):1084-1099. DOI
Book your assessment
Book a consultation with Dr. Kushner at COMEDSA. Bring any previous imaging for a complete assessment.
Educational information reviewed by Dr. Michael Kushner Shrem. It does not replace an in-person medical assessment.