14205 Avascular Necrosis Osteonecrosis

Overview

Avascular necrosis, also called osteonecrosis, means that a piece of bone is not getting enough blood and starts to die. Without enough blood, the bone weakens and may break down or collapse over time. It most often affects the hip, but can also affect the knee, shoulder, or other joints.

Avascular necrosis is not very common, but it is not rare either. It affects about 10,000 to 20,000 people each year in the UK. Many cases are linked to other conditions or treatments, such as long-term steroid use or heavy alcohol consumption.

Anyone can develop avascular necrosis, but it is most common in adults between 30 and 60 years old. It is more likely in people who have had major injuries, such as a broken bone or hip dislocation, and in people who take high-dose steroid medicines for a long time. It can also affect children, especially between age 4 and 10, often in the hip.

Symptoms

Common symptoms

• Pain in the affected joint, often the hip, groin, or knee
• Pain that gets worse when putting weight on the joint
• Limited movement or stiffness in the joint
• A limp or difficulty walking
• Pain that may be present even at rest or at night

Symptoms in children

• A limp that may come and go
• Pain in the hip, thigh, or knee (children often feel hip pain in the knee)
• Stiffness or reduced movement in the hip
• Sometimes no pain at first — the limp may be the only sign

Symptoms in older adults

• Gradual joint pain and stiffness
• Difficulty with everyday activities like getting out of a chair
• Pain that is similar to arthritis but may come on more suddenly
• In later stages, severe pain and trouble putting weight on the leg

Causes

Main causes

• A broken bone or joint injury that damages blood vessels near the bone
• Long-term use of high-dose corticosteroid medicines (such as prednisone or dexamethasone)
• Heavy alcohol use over many years
• Medical conditions such as lupus, sickle cell disease, or blood disorders
• Radiation therapy, chemotherapy, or organ transplantation treatments
• Sometimes the cause is unknown, even after tests are done

Risk factors

• Taking high-dose steroids for conditions like asthma, arthritis, or autoimmune disease
• Drinking more than a moderate amount of alcohol regularly
• Having a previous hip injury or dislocation
• Diabetes, high cholesterol, or other conditions that affect blood vessels
• Being a smoker
• Having blood disorders such as sickle cell disease or deep vein thrombosis

When to see a doctor

See a doctor urgently if:

• You have pain in a joint that is getting worse and makes it hard to walk or move
• You have a sudden limp or cannot put weight on a joint
• You have had an injury to a joint and now have severe pain or new trouble moving it

Book a routine appointment if:

• You have ongoing pain in a joint that has lasted more than a few weeks
• You have pain in the hip, knee, or shoulder that does not go away with rest
• You are at higher risk of avascular necrosis (for example, you take steroids or drink heavily) and you have new joint pain

Diagnosis

A doctor will ask about your symptoms, medical history, alcohol use, and any medicines you take. They will examine the joint and check how well you can move it. If avascular necrosis is suspected, they will usually order imaging tests. In the early stages, an MRI is the best way to see changes in the bone. X-rays may not show problems in the early phase but can show later damage.

Tests that may be done

• X-ray — often done first, but early changes may not show up
• MRI scan — the most sensitive test for early avascular necrosis
• CT scan — can show bone damage in more detail
• Bone scan — can help find areas of poor blood supply
• Blood tests — may be done to check for other conditions that affect bones

What to expect at your appointment

If you are referred for tests, the process usually takes a few weeks. An MRI is painless and involves lying still inside a scanning machine. Your doctor will go over the results with you and explain what they mean. If the diagnosis is confirmed, you will be referred to a bone specialist (orthopaedic doctor) who can discuss treatment options with you.

Treatment

Treatment depends on how much bone is damaged and which joint is affected. The goal is to protect the bone, slow damage, and keep the joint working. Early treatment is important because it can prevent the bone from collapsing. Your doctor may suggest non-surgical treatments first, but if the joint has already collapsed, surgery may be needed.

Self-care at home

• Rest the affected joint and avoid putting weight on it while it is painful
• Use a walker or crutches temporarily to reduce pressure on the joint
• Apply ice or heat to the area for comfort, but avoid direct ice on skin
• Follow a healthy eating plan to support bone strength
• Avoid heavy alcohol consumption and stop smoking
• Do gentle exercises that your doctor or physiotherapist recommends to keep the joint moving

Medical treatments

Medicines may be used to help manage pain and reduce inflammation. Your doctor may also recommend treatments to help preserve bone. These are general approaches and do not include specific drug names. In some cases, a doctor may suggest a procedure called core decompression, where a small tunnel is made into the bone to improve blood flow, or surgery to reshape or replace the joint. Always ask your healthcare provider about the treatment options that are right for you.

When is surgery considered?

Surgery is usually considered when the bone has started to collapse or if pain is severe and limits everyday activities. For the hip, a total hip replacement is a common and successful operation. For smaller areas, other procedures may be done to try to save the joint. Your orthopaedic surgeon will explain the risks and benefits before any procedure.

Living with this condition

Living with avascular necrosis means pacing yourself and listening to your body. Some days may be easier than others. Use pain as a guide — if an activity increases your pain, try to do less of it. A physiotherapist can show you safe ways to move, keep your muscles strong, and protect your joint.

Lifestyle tips

• If you drink alcohol, reduce it or stop entirely — heavy drinking worsens avascular necrosis
• If you smoke, ask your healthcare team about support to quit
• Maintain a healthy weight to reduce stress on your joints
• Take breaks during long periods of standing or walking
• Use assistive devices like a cane if they help you feel steadier
• Get good sleep — rest helps your body recover

Diet and exercise

Eating a balanced diet with plenty of calcium and vitamin D helps keep bones strong. Good sources include dairy products, leafy greens, and fortified foods. Gentle low-impact exercises like swimming, cycling, or stretching can help maintain joint movement without too much strain. A physiotherapist can create a safe exercise plan for you. Avoid high-impact activities like running or jumping if they cause pain.

Mental health and emotional wellbeing

Living with chronic pain and a health condition like avascular necrosis can be frustrating and stressful. You might feel anxious about the future or sad about not being able to do things you used to. These feelings are understandable. Talk to your doctor about how you are coping. Support from family, friends, or a counsellor can help. If you feel overwhelmed, please reach out to your local mental health services or a helpline in your area.

Prevention

Not always, but you can lower your risk. Avoid heavy alcohol use, do not smoke, and manage conditions like diabetes or high cholesterol. If you take steroid medicines long-term, ask your doctor about the lowest dose that works for you and whether you need regular monitoring. Protect your joints from injuries by using proper safety equipment during sport and avoiding falls. Early diagnosis is also important — if you have symptoms, see a doctor promptly.

Vaccines

There is no vaccine for avascular necrosis. However, staying up to date with recommended vaccines can help you avoid infections that might complicate your health.

Screening programmes

Routine screening for avascular necrosis is not standard for everyone. However, if you are at high risk — for example, you take long-term steroids or have sickle cell disease — your doctor may recommend periodic imaging tests to check the bones. Ask your healthcare provider if monitoring is right for you.

Complications

If left untreated

• The bone can collapse, leading to a deformed joint
• Severe arthritis in the affected joint
• Loss of joint function and mobility
• Chronic pain that may become constant
• Need for a joint replacement at a younger age than usual

Long-term outlook

Avascular necrosis is a serious condition, but there is a lot of hope. With early treatment, many people can stop the damage and keep their own joint working. If the joint has already collapsed, modern joint replacement surgery has excellent results and can greatly improve pain and mobility. Many people return to normal activities after treatment. The best thing you can do is follow your healthcare team's advice, stay active in a safe way, and keep a positive outlook.

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