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What is avascular necrosis?
Avascular necrosis of the femoral head (AVN, aseptic necrosis) is the death of bone tissue due to disruption of blood supply. The femoral head has a vascular anatomy that makes it vulnerable to ischemia. Without treatment, the bone softens, deforms, and deteriorates.
AVN is a serious condition affecting young people(average age 33-38 years). Without treatment, in 80% of cases within 2-3 years the femoral head collapses, requiring joint replacement.
Stages of AVN (Ficat-Arlet):
- Stage I — X-ray is normal, changes visible only on MRI. Minimal pain
- Stage II — sclerosis and cysts on X-ray, but femoral head shape is preserved
- Stage III — subchondral fracture ("crescent sign"), beginning of collapse
- Stage IV — femoral head collapse, flattening, secondary osteoarthritis
Risk factors:
- Prolonged corticosteroid use
- Alcohol abuse
- Femoral neck fracture or dislocation
- Sickle cell anemia
- Autoimmune diseases (SLE)
- Chemotherapy and radiation therapy
Facts about AVN
- ICD-10: M87.0
- Age: 20-50 years (average 33-38)
- Bilateral: in 50-80% of patients
- Without treatment: collapse in 80% within 2-3 years
- Share of all joint replacements: 5-12%
Symptoms of femoral head avascular necrosis
Early signs
- Groin pain that develops gradually
- Pain with weight-bearing on the leg
- Limited hip rotation
- Discomfort in the buttock and knee
- May be asymptomatic at Stage I
Progression
- Increased pain, pain at rest
- Limping, leg shortening
- Significant limitation of motion
- Thigh muscle atrophy
- Inability to bear weight on the leg (in case of collapse)
⚠️ Important
- Early consultation is critically important
- At stages I-II, the joint can be saved
- In case of groin pain — urgent MRI
- X-ray at stage I shows nothing
- Only MRI detects early Avascular Necrosis of the Femoral Head
Avascular necrosis of the femoral head: treatment options and what is known about them
The treatment plan is made by the clinic doctor after an examination and a review of your images. The table shows the options usually discussed for this diagnosis and how well they have been studied.
| Option | What to expect | How well studied |
|---|---|---|
| Load management, weight loss | Takes load off the affected area; if overweight, losing 5–10% noticeably reduces pain | Moderate evidence |
| Painkillers and NSAIDs | Ease pain during flare-ups; long-term use is limited by side effects | Moderate evidence |
| BMAC / MFAT | Cell preparations from bone marrow or fat; more expensive, no proven advantage over PRP | Limited or conflicting evidence |
| PRP / CGF | Concentrate from your own blood; may reduce pain, growth of new tissue has not been shown | Little data |
| Core decompression or hip replacement | If conservative treatment does not help or there is an indication | When indicated — the doctor decides |
We send your request to several partner clinics. Some will suggest conservative treatment or injections, others surgery; each clinic quotes its own conditions and price. We help you compare the options.
Regenerative methods: realistic expectations
In avascular necrosis everything depends on the stage. In early stages, before the femoral head collapses, offloading and core decompression are used; in some studies adding bone marrow concentrate (BMAC) improved results, but the data are still limited. After collapse and joint destruction, regenerative methods do not help — hip replacement is usually discussed.
When surgery is discussed. In the early stage — core decompression of the femoral head (sometimes combined with BMAC); in the late stage — hip replacement.
If an injection helps, the effect usually builds up over 6–12 weeks, and the result is assessed after 2–3 months. No clinic can guarantee a result.
Good to know: diagnosis, self-help, outlook
How to recognise avascular necrosis of the femoral head
Early signs are groin or thigh pain when walking, later also at rest, and limited hip rotation. People at risk include those on long-term corticosteroids, with alcohol misuse, after injuries and with clotting disorders. In the early stage the X-ray may be normal, so MRI is needed when necrosis is suspected — it detects it before the head collapses. Hip osteoarthritis, a labral tear and a femoral neck stress fracture cause similar pain.
What you can do yourself
If necrosis is suspected, do not delay the MRI and orthopaedic visit. Offload the joint — walk with a cane or crutches as advised and avoid running and jumping. Where possible, reduce corticosteroids together with your treating physician and stop drinking alcohol.
Outlook and timelines
Without treatment the disease progresses to head collapse in many people within months or a few years. In early stages joint-preserving treatment — core decompression, sometimes with bone marrow cells — is discussed, but halting the disease cannot be guaranteed. After collapse and secondary osteoarthritis, hip replacement is usually recommended.
Who it is not suitable for and possible risks
Contraindications
- Active infection — at the injection site or systemic, with fever.
- Active cancer or ongoing chemotherapy.
- Blood clotting disorders or a low platelet count. Anticoagulants are discussed with the physician.
- Pregnancy and breastfeeding — the procedure is usually postponed.
- A corticosteroid injection into the same area in recent weeks.
- Severe stage IV osteoarthritis with axial deformity and joint destruction — joint replacement is usually discussed instead.
Possible risks
- Pain and swelling at the injection site for 1–3 days.
- Bruising where blood or fat tissue is taken.
- Rarely, infection. The procedure is therefore performed under sterile conditions with ultrasound or X-ray guidance.
- The effect may be absent or smaller than expected.
If any of these apply to you, mention it in your request. The coordinator will check with the clinic physician whether treatment is possible. Contact a coordinator.
Scientific evidence
Studies of regenerative methods show mixed results. Clinic physicians rely on research including the following:
- Ye Y et al. Platelet rich plasma versus hyaluronic acid in patients with hip osteoarthritis: A meta-analysis of randomized controlled trials. Int J Surg, 2018.
- Bannuru RR et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage, 2019.
Next steps: Treatment methods · Treatment cost · How treatment in Germany is organised
Frequently Asked Questions About Avascular Necrosis Treatment
RegenPAS is a patient service centre in Munich, not a clinic. We review your images and symptoms and send a request to several partner clinics at once. Clinics that can accept you send their own conditions and price; prices differ between clinics, and you choose the option that suits you. The coordinator replies within 24 hours, and a clinic physician’s preliminary opinion follows in 1–3 business days. We then arrange the appointment, visa invitation, interpreter, transfers and accommodation. Treatment decisions are made by the clinic physician. Contact a coordinator.
Your MRI (or CT, X-ray) report and the images if you have them, plus a short description of your symptoms and previous treatment. Send them via the form on the website — the assessment is free and without obligation: the coordinator replies within 24 hours, and the clinic physician’s preliminary opinion follows in 1–3 business days.
Clinic and method matching — free of charge
Describe your case and attach your MRI report. We will identify clinics that use the relevant methods and forward your request to them. No obligation; we reply within 24 hours.
Send a request