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Symptoms

  • Symptoms of avascular necrosis can be variable and often times there is no pain at first. The most common symptom is hip pain, typically in the groin region.  In the earliest stages of the disease plain x-rays are often normal. A magnetic resonance image (MRI) study can allows us to detect avascular necrosis earlier than x-rays.
  • Does avascular necrosis cause pain?
    Avascular necrosis may be present without any pain whatsoever. There may be pain during early stages of the disease but sometimes pain develops once the degree of bone death has progressed quite far. Once the disease has progressed to a point where the bone can no longer support the stress of bearing weight, the top of the femoral ball can collapse.  It is always important to have the other hip checked as it may also be affected.
  • How often is the other hip affected?
    It may be necessary to verify the health of the opposite hip when evaluating avascular necrosis because studies have shown that the opposite hip may not hurt, have normal x-rays, but may be affected up to 80% of the time.
  • Will it get worse?
    The progression of avascular necrosis is linked to the size of the area of dead bone. Very small areas may improve without surgery.  Larger areas often progress to collapse of the femoral ball.

We can diagnose avascular necrosis with x-rays and MRI. There are four stages that define how bad the disease has progressed. Stage 1 has a normal x-rays but MRI reveals the dead bone. Stage 2 can be seen on regular x-ray but there is no collapse of the femoral ball. Stage 3 shows signs of collapse (called a crescent sign) on x-ray. Stage 4 has collapse on x-ray and signs of cartilage damage (osteoarthritis).