Avascular necrosis (also called osteonecrosis) occurs when blood supply to a section of bone is disrupted, causing that bone tissue to weaken and, if untreated, potentially collapse. Catching it early gives the best chance of preserving your own joint rather than needing a replacement later — Dr. Juilee Mhatre Nair explains what to watch for and how it is managed.
What avascular necrosis is
Bone tissue, like any other tissue in the body, needs a steady blood supply to stay alive. When that supply is interrupted — from injury, certain medications, or other risk factors — the affected section of bone can begin to die. Over time, this weakens the bone's structure, and in advanced cases the joint surface can collapse, leading to arthritis and significant joint damage. It most commonly affects the hip, but can also occur in the knee, shoulder, and other bones.
Who this suits
This page is relevant if you have unexplained, persistent joint pain — particularly in the hip or knee — along with known risk factors such as long-term corticosteroid use, significant alcohol intake, a blood disorder like sickle cell disease, a history of joint trauma, or an autoimmune condition. It is also relevant if you have already been told you may have early-stage avascular necrosis and want to understand joint-preserving options before considering surgery.
Causes and risk factors
- Trauma — fractures or dislocations that damage the blood vessels supplying the bone, particularly around the hip.
- Long-term corticosteroid use — a well-recognised risk factor, thought to be linked to fat deposits affecting blood flow in small vessels.
- Excessive alcohol use — can similarly affect blood vessel function and reduce bone blood supply.
- Blood disorders — conditions such as sickle cell disease can cause blockages in the small vessels supplying bone.
- Autoimmune conditions — such as lupus, which can cause inflammation affecting blood vessels.
- Idiopathic cases — sometimes no clear cause is found despite thorough assessment.
Symptoms
The most common symptom is a deep, aching pain in the affected joint that typically worsens with weight-bearing activity and improves with rest — this pattern can make early avascular necrosis easy to mistake for ordinary joint strain. As the condition progresses, patients often notice increasing stiffness, a limp if the hip is involved, and eventually signs of joint collapse and arthritis if it is not caught and managed early.
Non-surgical management first
In early stages, before significant bone collapse, treatment focuses on preserving the joint: pain relief, reduced weight-bearing on the affected joint, physiotherapy to maintain mobility and support surrounding muscles, and medications such as bisphosphonates that may help slow bone breakdown. This is genuinely the priority in early disease — the earlier avascular necrosis is identified, the better the chance that joint-preserving measures can work.
The surgical option and what it involves
When conservative measures are not enough, or the disease is caught at a stage where structural intervention can help, joint-preserving surgical options include core decompression (removing a portion of inner bone to relieve pressure and encourage new blood vessel growth), sometimes combined with bone grafting, or an osteotomy to reduce stress on the affected area. In advanced cases where the joint has already collapsed, a joint replacement procedure — such as /hip-replacement-surgeries/ or, if the knee is affected, /total-knee-replacement/ or /partial-knee-replacement/ — may be the more realistic option to relieve pain and restore function.
What precision-assisted planning changes, where used
If joint replacement becomes necessary because of advanced avascular necrosis, imaging-based and, where available, robotic-assisted planning can help the surgical team map the joint's anatomy and guide precise implant alignment. This applies to the replacement procedure itself, not to earlier joint-preserving treatments like core decompression, and it remains a planning and precision aid rather than a guarantee of a specific result.
Why early diagnosis matters
Avascular necrosis is typically described in stages, from early changes visible only on MRI, through to advanced disease with visible bone collapse and secondary arthritis on X-ray. The treatment options available narrow considerably as the disease progresses — joint-preserving procedures such as core decompression are generally most useful before collapse has occurred, while joint replacement becomes the more realistic option once the joint surface itself has been damaged. This is why prompt assessment matters if you have known risk factors, such as long-term steroid use or a relevant blood disorder, even before symptoms become severe.
Recovery phases
Recovery after joint-preserving surgery such as core decompression generally involves a period of protected or reduced weight-bearing, followed by gradual return to normal activity guided by your surgeon's assessment of healing. If joint replacement is required, recovery follows the same phased approach used for hip or knee replacement more broadly — early mobilisation, structured physiotherapy, and gradual return to activity.
Risks, discussed honestly
Without treatment, avascular necrosis can progress to joint collapse, leading to arthritis, chronic pain, and reduced mobility. Joint-preserving surgery itself carries risks such as infection and the possibility that the procedure does not halt progression, in which case joint replacement may still eventually be needed. These risks are discussed individually based on how advanced your condition is at diagnosis.
What influences the cost
Costs vary depending on whether joint-preserving surgery or joint replacement is required, the hospital setting, length of stay, and the rehabilitation plan afterward, along with your insurance or cashless coverage. We do not publish a fixed figure — call or WhatsApp the clinic for a personalised estimate once your case has been assessed.
What a consultation involves
A consultation includes a review of your risk factors and symptom history, a physical examination, and MRI review where needed — MRI is the most sensitive way to detect early avascular necrosis, often before changes appear on X-ray. Dr. Juilee Mhatre Nair consults at /spine-and-knee-clinic-kharghar/ and at /spine-and-knee-specialist-kopar-khairane/. Learn more about her focus areas on the /dr-juilee-mhatre-nair/ page.
Frequently asked questions
Avascular necrosis develops when blood supply to a section of bone is disrupted. Common causes include trauma such as fractures or dislocations that damage nearby blood vessels, long-term corticosteroid use, excessive alcohol consumption, certain blood disorders such as sickle cell disease, and autoimmune conditions. In some cases, no clear cause is identified, and it is described as idiopathic avascular necrosis.
In early stages, before bone collapse has occurred, some patients are managed with pain relief, activity modification to reduce weight-bearing stress, and medications such as bisphosphonates that may help slow progression. This joint-preserving approach is more likely to succeed the earlier the condition is caught, which is why prompt assessment matters if you have risk factors or early symptoms.
Core decompression is a joint-preserving surgical procedure typically used in earlier stages of avascular necrosis, before significant bone collapse. It involves removing a portion of the inner bone to reduce internal pressure and create space that may allow new blood vessels to form and improve blood flow to the affected area. It is sometimes combined with bone grafting for additional support.
Not necessarily — this depends on how early the condition is caught and how far it has progressed. Early-stage avascular necrosis may respond to joint-preserving treatment, while advanced cases with significant joint collapse are more likely to need hip replacement surgery or a knee procedure such as total knee replacement, depending on which joint is affected. Dr. Juilee Mhatre Nair will assess your imaging to determine the stage and discuss realistic options.
The hip is the most commonly affected joint, but avascular necrosis can also occur in the knee, shoulder, and other bones. Symptoms and treatment principles are broadly similar across joints, though the specific surgical options differ depending on which joint is involved.
Talk to a spine and joint specialist
Share your symptoms, reports or scans and our team will help you book a consultation with Dr. Vishnu Vikraman Nair or Dr. Juilee Mhatre Nair at the Navi Mumbai location most convenient for you.