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This condition is caused by a localised failure of blood supply to the bone of the femoral head. The bone becomes soft and mis-shapen, even if the blood supply returns it is likely that the joint will become arthritic.

Hip joint before avascular necrosis Hip Joint AVN Diagram Hip joint after avascular necrosis, significant bone destruction. No surgery

What causes AVN?

In the majority of cases a single cause cannot be identified; we call this idiopathic AVN. Blockage of the end arteries feeding the femoral head may occur as part of many different diseases, or as a complication of treatments. (e.g. Steroids, Alcoholism, Bisphosphonates, Radiotherapy, Sickle cell anaemia, Vasculitis) Disruption of the blood supply to the femoral head may follow fractures or dislocation of the hip joint.

How can we confirm a diagnosis of AVN?

In the beginning this condition causes hip pain which is fairly constant and unrelated to the position of the leg. If the condition progresses to deformity of the joint surfaces then mechanical symptoms will develop. Finally after time the symptoms reflect the development of secondary osteoarthritis.

What treatments are available?

Most patients only come for treatment after the hip has deformed and become arthritic. In these cases once the symptoms are severe enough a total hip replacement is the best treatment.

Very occasionally we see these cases early enough to try and salvage the hip joint. A large number of operations have been described to try and help healing in this condition. There is no clear winning operation for all stages of the condition.

There is a section in the teaching zone covering the diagnosis and treatment of AVN.

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