Consultant, Orthopaedics & Joint Replacement, Artemis Hospital, Gurgaon
Part 6 of 12 in Spectrum of Orthopaedic Disorder - Evaluation and Management
Avascular Necrosis of the Hip: Causes, Stages and Treatment
September 6, 2026
Avascular necrosis of the hip develops when the blood supply to the head of the femur is cut off, and the bone begins to die. Dr. Lamba identified two causes as the most significant drivers he sees in practice: steroid use and sickle cell disease.
Why an early diagnosis needs an MRI, not just an X-ray
Patients with avascular necrosis typically present with pain first, at a stage when the X-ray still looks normal. It is only on MRI that the diagnosis becomes clear, which is why Dr. Lamba moves to MRI whenever a patient's pain does not match a normal-looking X-ray.
Steroid use, and a rise during the pandemic
One major driver of avascular necrosis is steroid use, which Dr. Lamba noted increased significantly during the Covid pandemic. Sickle cell disease is the other major cause he encounters, and is discussed separately given how differently those cases need to be managed.
Treatment depends on the stage
In the early stages, stage one and stage two, avascular necrosis can sometimes be managed with medication or with a joint-preserving procedure called core decompression combined with stem cell grafting. Once the disease has progressed to advanced arthritis, a total hip replacement becomes the only effective option. Dr. Lamba showed one such case where both hips were replaced in the same sitting, with the patient walking well afterward.
This article is based on a Jivo Masterclass session conducted by Dr. Rohit Lamba, Consultant, Orthopaedics & Joint Replacement, Artemis Hospital, Gurgaon. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
This guide is based on a live Jivo Masterclass: Dr. Rohit Lamba taught doctors across Africa on April 6, 2025.
FROM THE LIVE Q&A
Doctor on the call (name unclear from transcript)
Is there a definitive treatment for arthritis?
Dr. Rohit Lamba
Dr. Lamba answered on the assumption the question was about rheumatoid arthritis, since a network issue had cut off part of the question. In the early stage, before the cartilage is damaged, it can be managed well with disease-modifying antirheumatic drugs (DMARDs); cases that do not respond well can move to biological disease-modifying drugs, but only after full evaluation by an orthopaedic surgeon or rheumatologist. Once the cartilage is already damaged, the definitive treatment is hip replacement, and with current implants a patient can expect to stay pain-free and active for the next 30 to 35 years.
Frequently Asked Questions
Which group of patients is hip replacement surgery indicated for?▼
Dr. Lamba outlined four categories. The first is congenital deformity, such as developmental dysplasia of the hip, where the hip is out of the socket from birth. The second is a childhood infection, Perthes disease, or a slipped epiphysis that reshapes the hip and leads to arthritis later in life. The third is avascular necrosis that has reached an advanced, arthritic stage in early adulthood. The fourth is a hip fracture that has not united properly, healing in a poor position that causes arthritis and pain.
Is there a definitive treatment for arthritis?▼
Dr. Lamba answered on the assumption the question was about rheumatoid arthritis, since a network issue had cut off part of the question. In the early stage, before the cartilage is damaged, it can be managed well with disease-modifying antirheumatic drugs (DMARDs); cases that do not respond well can move to biological disease-modifying drugs, but only after full evaluation by an orthopaedic surgeon or rheumatologist. Once the cartilage is already damaged, the definitive treatment is hip replacement, and with current implants a patient can expect to stay pain-free and active for the next 30 to 35 years.
What causes avascular necrosis of the hip?▼
Dr. Lamba identified steroid use, which he noted rose significantly during the Covid pandemic, and sickle cell disease as the two major causes.
Why can an X-ray miss avascular necrosis?▼
Patients often have pain while the X-ray still looks normal; the diagnosis usually only becomes clear on an MRI scan.
How is avascular necrosis treated?▼
Early stages can sometimes be managed with medication or core decompression combined with stem cell grafting. Advanced, arthritic stages need a total hip replacement.
In This Series: Spectrum of Orthopaedic Disorder - Evaluation and Management
- 1.Spectrum of Orthopaedic Disorders
- 2.Understanding the Main Causes of Knee Arthritis
- 3.How Robotic and Computer-Navigated Systems Are Used in Joint Replacement
- 4.Developmental Dysplasia of the Hip: Treating a Childhood Hip Problem
- 5.Perthes Disease: When Childhood Hip Damage Surfaces Years Later
- 6.Avascular Necrosis of the Hip: Causes, Stages and Treatment
- 7.Hip Replacement and Sickle Cell Disease: Why Blood Transfusion Comes First
- 8.When Is Hip Replacement the Right Treatment?
- 9.ACL and Ligament Reconstruction: Grafts and When Surgery Is Needed
- 10.Treating Fracture Non-Union and Bone Infection with External Fixators
- 11.Reconstructing Severe Trauma: Distraction Osteogenesis for Bone and Limb Loss
- 12.Vitamin D Deficiency in Children: When Rickets Requires Corrective Knee Surgery