Osteonecrosis of the Hip (Avascular Necrosis) | The Back Pain Doctor Brisbane

Osteonecrosis of the Hip (Avascular Necrosis) — assessment and management in Brisbane

Osteonecrosis of the hip, also called avascular necrosis, occurs when the blood supply to the head of the thighbone is disrupted and the bone gradually dies and collapses. Early diagnosis matters, because treatment options narrow once collapse occurs.

Osteonecrosis of the hip, also known as avascular necrosis, develops when the blood supply to the femoral head is interrupted. The bone gradually dies and can collapse, taking the overlying cartilage with it and leading to arthritis of the joint.

Assessment focuses on identifying the condition early and distinguishing it from hip osteoarthritis, gluteal tendinopathy and referred lumbar spine pain. A key point is that plain X-rays are commonly normal in the early stages, so persistent groin or buttock pain with a normal X-ray warrants further consideration rather than reassurance — particularly where risk factors such as long-term corticosteroid therapy, heavy alcohol use or previous hip injury are present. MRI is the investigation that establishes the diagnosis and stage.

Management here is diagnostic clarification, analgesia, offloading advice and prompt orthopaedic referral. Hip-preserving procedures are only possible before the femoral head collapses, so the timeline matters. The clinic’s non-surgical regenerative and shockwave treatments do not have an established role in this condition, and it would be misleading to suggest otherwise.

Common symptoms

Groin or buttock pain, often a dull ache or throbbing
Pain that worsens with standing and weight-bearing
Severe pain but relatively preserved hip movement early on
Progressive stiffness and loss of motion as the condition advances

Evidence-informed treatment summary

How our treatment options may fit for Osteonecrosis of the Hip (Avascular Necrosis)

The options below include the treatments offered at The Back Pain Doctor. Listing a treatment does not mean it is recommended for this condition. The evidence, likely benefit and role of each option are considered against the diagnosis, examination findings, imaging where appropriate, patient goals, risks, cost and alternatives.

Foundation

Diagnosis, education and progressive rehabilitation

This is the starting point for most musculoskeletal conditions.

The priority is to identify the likely pain generator, explain the condition clearly, modify aggravating load and build a realistic plan to restore strength, movement and confidence.

Condition-dependent

Focused / radial shockwave therapy

Evidence is condition-specific; it is not a universal pain treatment.

Shockwave is best framed as an adjunct where the diagnosis fits. It is generally more established for selected tendon and plantar heel pain presentations than for many joint or nerve conditions.

Selected cases

Platelet-rich plasma (PRP)

Evidence varies substantially by condition, tissue and preparation method.

PRP may be discussed in selected tendon or joint presentations. It should not be presented as a guaranteed regenerative treatment, and uncertainty, cost and alternatives should be discussed.

Symptom relief

Image-guided corticosteroid / local anaesthetic injection

Best used for specific inflammatory or irritable pain generators, usually for short-term relief.

An injection may help when a joint, bursa, tendon sheath or other defined structure is driving symptoms. It is not a cure and needs to be weighed against risks, recurrence and the need for rehabilitation.

Emerging adjunct

EMTT / magnetotransduction

Clinical evidence is still developing and guideline support is limited.

EMTT may be discussed as an adjunct in selected presentations, but should be presented with clear uncertainty and never as a replacement for diagnosis, load management or rehabilitation.

Selected cases

Prolotherapy

Evidence is condition-specific and generally less established than exercise-based care.

Prolotherapy may be considered in carefully selected chronic ligament, tendon or joint-related pain presentations, but it is not a first-line treatment.

Pain modulator

Trigger point / myofascial treatment

Most relevant when focal myofascial pain is a clear contributor.

Trigger point treatment may reduce pain from focal muscle spasm or myofascial tenderness. It should be paired with movement restoration, strength work and recurrence prevention.

Nerve-specific

Nerve-focused treatment / hydrodissection

Relevant only when the history and examination support nerve irritation or entrapment.

Nerve-focused treatment may be discussed when there is a plausible peripheral nerve pain generator. Progressive weakness, major neurological deficit or red flags require a different pathway.

This is general information only. Suitability is assessed individually. Treatments with limited or condition-dependent evidence may still be discussed, but only with clear explanation of uncertainty, expected benefit, risks, cost and alternatives. Red flags, progressive neurological symptoms or suspected serious pathology require a different pathway.

Frequently asked questions

How is hip osteonecrosis diagnosed?

Diagnosis is based on symptoms, examination and imaging. Plain X-rays are often normal in early disease, so a normal X-ray does not exclude it. MRI detects early changes, shows how much bone is affected, and may identify disease in the opposite hip before symptoms appear.

Who is at higher risk?

Recognised risk factors include previous hip fracture or dislocation, long-term corticosteroid use, heavy alcohol intake, sickle cell disease, lupus, and several other medical conditions. It is more common between the ages of 40 and 65, and both hips are affected in many cases.

What does treatment involve?

Non-surgical measures such as analgesia, activity modification and offloading with crutches can help symptoms, but the definitive treatments are surgical. Hip-preserving surgery is only an option before the femoral head collapses, which is why timely diagnosis and orthopaedic referral matter.

Ready for a clearer plan for your back or musculoskeletal pain?

Book an assessment with Dr Joshua Hatch.

Your assessment focuses on understanding the likely source of your pain and the most appropriate non-surgical options for your diagnosis, with the aim of reducing pain and improving function.

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