Avascular Necrosis of the Hip: Why It Is So Common in India and What Can Be Done

Avascular necrosis of the hip, often shortened to AVN and also called osteonecrosis, is a condition where the ball at the top of the thigh bone loses its blood supply. When bone does not get enough blood, its living cells begin to die, and over time the bone can weaken and collapse. In India, this has become one of the more common reasons that otherwise healthy, active adults develop serious hip pain.

The word necrosis can sound frightening, and it is natural to feel worried. The honest truth is that AVN is serious and does not usually go away on its own. But there is good news too: when it is found early, there are real ways to protect your hip, and even in advanced cases, modern surgery can give you back a comfortable life. This article explains what is happening and what can be done.

KEY TAKEAWAYS

AVN of the hip means the ball of the joint is slowly losing its blood supply, which causes bone to weaken and, if untreated, to collapse.

It often affects younger adults, commonly in their 30s to 50s, which is one big reason that finding it early matters so much.

Common causes in India include steroid intake, alcohol, sickle cell disease, and hip injury; many cases have no clear cause, and doctors have reported a rise after steroid treatment for COVID-19.

The first sign is usually pain in the groin, especially when you stand or walk; stiffness and a limp tend to come later.

An MRI scan can detect AVN early, before the bone collapses, which is exactly when joint-preserving treatment works best.

Both hips are affected in a large share of patients, so your doctor may check the other hip even if it does not hurt yet.

What avascular necrosis of the hip really means

The blood supply is the key. Your hip is a ball-and-socket joint. The ball, which is the head of the thigh bone (doctors call it the femoral head), sits inside a cup-shaped socket in the pelvis. Like every living tissue, this ball of bone needs a steady flow of blood. In AVN, that flow is reduced or cut off, and the bone begins to starve.

When bone cells lose their blood supply, they die. This is the necrosis part of the name. The bone does not crumble straight away; the process usually unfolds over months. At first the ball keeps its round shape and pain may be the only clue. But weakened bone under the smooth joint surface can slowly flatten and collapse. Once the ball is no longer round, it grinds inside the socket, the joint wears out, and painful, stiff arthritis sets in. It helps to know that AVN is not cancer and not an infection; it is simply a problem of blood supply and bone.

Why it often affects younger adults, and why that matters

Unlike ordinary wear-and-tear arthritis, which mostly affects older people, AVN commonly appears in people in their 30s to 50s, and sometimes even younger. In many reports it affects men more often than women, though it certainly occurs in women too.

This younger age matters. A person in the prime of working and family life is facing a hip problem that can affect their job and independence, and a younger patient also has many active years ahead in which untreated damage can progress. That is why unexplained groin or hip pain in a young or middle-aged adult should never be brushed aside; catching AVN early can be the difference between saving your own hip and needing it replaced.

Common causes and risk factors: the Indian picture

Several things can reduce the blood flow to the ball of the hip. In India, the following are seen most often.

Steroid intake: high-dose or long-term corticosteroids (such as prednisolone or dexamethasone) are one of the most common causes. These medicines are important and often necessary for conditions like severe asthma and arthritis. The risk of AVN tends to rise as the total dose taken over time increases.
The COVID-19 connection: during the pandemic, many seriously ill patients were given steroids, which were often life-saving. In the months and years that followed, doctors in India and elsewhere reported a rise in AVN of the hip, frequently in people in their 40s, with symptoms often appearing weeks to months after the illness. Importantly, not everyone who received steroids develops AVN; for most people the risk is small.
Alcohol: regular heavy drinking over many years can lead to fatty deposits that block small blood vessels feeding the bone.
Sickle cell disease and some other conditions, such as lupus: these can block or damage the tiny vessels that supply the femoral head.
Injury: a fracture near the hip or a dislocation can tear the blood vessels to the ball directly.
Deep-sea diving and decompression sickness (the bends): a less common cause.
No clear cause (idiopathic): in a fair number of patients no single cause is ever found, and this does not mean anything was missed.

It is worth staying calm here. Having one of these risk factors, or taking a short course of steroids, does not mean you will definitely get AVN. Most people do not; these are things that raise the chance, not certainties. If you took steroids during COVID-19 and have no hip pain today, there is no need to panic: simply mention it to your doctor, and seek a review if pain appears later. Never stop a prescribed steroid suddenly on your own; always adjust it with your doctor's guidance.

Symptoms: what you might feel

In its earliest stage, AVN can be completely silent. The first symptom, when it comes, is usually pain felt deep in the groin, and sometimes in the buttock or the front of the thigh. Because it sits in the groin rather than on the outside of the hip, this pain is often mistaken for a muscle strain.

Pain in the groin that is worse when you stand, walk, or put weight on the leg.
Pain that eases with rest in the early stages, but that later becomes present even at rest and at night.
As the ball begins to collapse, growing stiffness and reduced movement, with difficulty crossing your legs, sitting cross-legged on the floor, squatting, or using an Indian-style toilet.
A limp when walking, and trouble climbing stairs.

The pain often builds gradually over weeks to months. A fairly sudden increase can signal that the weakened bone has started to collapse. Do not wait for severe pain before seeking help; earlier is always better.

How AVN is diagnosed, and why early matters

Your doctor will begin by asking about your symptoms and history, including any steroid use, alcohol intake, blood conditions, and past hip injuries, and will then examine your hip. A telling early sign is a hip that still moves reasonably well but is painful, because at that stage only the ball is affected.

An X-ray is usually the first test. It is useful, but it can look completely normal in early AVN, because the bone has not yet changed shape. X-ray changes tend to appear only later, once collapse has begun.

MRI is the key test. Magnetic resonance imaging (MRI) is the most sensitive way to find AVN. It can detect the condition very early, before any changes show on X-ray and, crucially, before the bone collapses. So if AVN is suspected but the X-ray is normal, an MRI is strongly recommended. This early window matters, because once the ball has collapsed that change cannot be reversed, whereas before collapse your own hip can often be saved.

Treatment by stage, explained simply

Treatment depends mainly on one question: has the ball of the hip already collapsed? Before collapse, the aim is to preserve your own hip; after collapse, it shifts to replacing the worn-out joint. Your doctor will also address any underlying cause, such as reducing alcohol or reviewing your steroids.

Joint-preserving treatment for early AVN. When AVN is caught before or at the very start of collapse, several options can protect the hip: activity modification, such as reducing weight through the joint and using a stick or crutches; medicines for pain and, in some cases, bone-protecting drugs; and a common procedure called core decompression, in which the surgeon drills small channels into the ball to relieve pressure and encourage new blood vessels to grow. Core decompression may be combined with a bone graft (your own bone, donor bone, or a synthetic material) or with newer biologic techniques, such as adding bone marrow cells. These approaches work best before the bone collapses.

Total hip replacement for advanced AVN. Once the ball has collapsed and the joint has become arthritic, total hip replacement is the most reliable treatment. In this operation, done under anaesthesia, both the worn ball and the socket are replaced with smooth artificial parts. It is very successful at relieving pain and restoring movement, and modern implants are long-lasting. Because AVN patients are often young, a second operation to renew the implant may be needed later in life, but for most people it gives many years of comfortable, active living.

A simple guide to AVN treatment by stage

Stage of AVN	What is happening to the bone	Usual treatment aim
Very early (before collapse)	Bone is starting to die but the ball is still round; often seen only on MRI	Preserve the hip: activity change, medicines, core decompression
Early with small changes	Early damage, ball still round or nearly so	Core decompression, with or without bone graft or biologic techniques
Collapse begins	The surface of the ball starts to flatten	Some hips can be preserved, but many move towards replacement
Advanced (collapse with arthritis)	The ball has collapsed and the joint is worn	Total hip replacement

When both hips are affected

One fact often surprises patients: in many people, AVN affects both hips, even when only one is painful. This is because the underlying causes, such as steroids, alcohol, and blood conditions, act on the whole body rather than on a single joint. Sometimes AVN is found quietly developing in the second hip on an MRI, before it has caused any pain.

This is why your doctor may want to image both hips even if only one is troubling you. Far from being bad news, finding silent early AVN in the second hip is an opportunity: it allows joint-preserving treatment on that side before pain and collapse ever begin.

What to expect: a realistic outlook

AVN is serious and tends to progress if left untreated, especially once collapse has begun. But the overall outlook is realistic and often good, particularly when the condition is caught early. Early joint-preserving treatment can slow or halt the damage in many patients, and for those who need a replacement, the results for pain relief and movement are generally excellent.

Your own part matters too. Attending your follow-up scans, working with your physiotherapist, and tackling risk factors all help protect your hips. Above all, do not ignore new or worsening groin pain, especially if you have taken steroids, drink heavily, or have sickle cell disease. With the right care, AVN is a manageable condition, not a hopeless one; your orthopaedic team can guide you to the treatment that fits your stage, and seeking advice early is genuinely worthwhile, because this is one of those conditions where timing changes what is possible.

Questions patients commonly ask

“I have hip AVN but the pain is mild. Can I just wait?” Waiting is risky. AVN often progresses silently until the ball of the joint collapses, and once it collapses the joint-preserving options are gone and replacement becomes the only route. Early AVN is exactly when treatment works best, so it is followed closely rather than left alone.

“I am in my thirties. Do I really need a hip replacement so young?” Not always. Caught early, before collapse, there are joint-preserving operations such as core decompression that can buy time and sometimes avoid replacement. If the head has already collapsed, replacement gives reliable relief, and modern implants in a young patient are planned with the expectation that a revision may be needed later in life.

“My other hip does not hurt. Should it be checked?” Yes. AVN affects both hips in a large share of patients, and the second hip is often silent in its early stages. An MRI of the painless hip is worthwhile, because finding it early is what keeps the joint-preserving options open.

“Did steroids cause my AVN?” Steroids and alcohol are the two commonest identifiable causes, but many cases have no clear cause at all. If you have taken steroids for any reason, it is worth knowing that even short high-dose courses have been linked to AVN. This is not a reason for guilt, it is a reason to have hip pain checked promptly.

THE BOTTOM LINE

AVN of the hip is a loss of blood supply to the ball of the joint that can lead the bone to weaken and collapse, and it often affects younger, active adults.

The most helpful thing you can do is act early: unexplained groin pain, especially if you have taken steroids, drink heavily, or have sickle cell disease, deserves prompt assessment, and an MRI can find AVN before lasting damage.

Early AVN can often be treated with joint-preserving options such as core decompression, while a collapsed, arthritic hip is usually treated very successfully with total hip replacement.

You do not have to face this in fear; with timely care, most people with AVN go on to live comfortable, active lives.