Persistent Hip Pain in Young Adults: Symptoms of Avascular Necrosis (AVN)

Hip pain that appears at a young age and lasts a long time is often ignored and attributed to muscle strain, intense exercise, or daily activities. However, hip pain that does not go away for weeks or even months and gradually worsens may have a more serious health problem underneath. One of these diseases is avascular necrosis (AVN), an important orthopedic condition that affects the hip joint.

Avascular necrosis develops when bone tissue loses its vitality because the bone is not adequately supplied with blood. If it is not recognized in the early period, collapse of the bone structure can occur and permanent damage can develop in the hip joint. For this reason, unexplained hip pain in young and middle-aged adults should be evaluated carefully.

This article covers the causes, symptoms, diagnostic methods, and current treatment options for avascular necrosis in detail.

What Is Avascular Necrosis (AVN)?

Avascular necrosis is a disease also described in everyday language as “impaired bone circulation” or “bone death.” It is most often seen in the upper part of the thigh bone (the femoral head) that forms the hip joint.

Normally, bone tissue is continuously nourished by blood vessels. When this blood flow is disrupted for any reason, bone cells cannot receive enough oxygen and nutrients. Over time the bone tissue weakens, loses its strength, and a risk of collapse appears.

AVN may not cause symptoms in the early stage; as it progresses it can lead to severe pain and limited motion.

In Whom Is Avascular Necrosis Seen?

Although AVN can appear at any age, it is most common in adults between 30 and 50. It is seen a little more often in men than in women.

People at risk include:

• Those who use high-dose corticosteroids for a long time
• People who drink excessive alcohol
• Those who have had hip trauma or fracture
• Those with a history of hip dislocation
• Patients with blood-clotting disorders
• People with certain blood diseases such as sickle cell anemia
• Those with autoimmune diseases such as lupus
• Those who use immunosuppressive drugs after organ transplantation
• Divers or occupational groups exposed to sudden pressure changes

In some patients, however, avascular necrosis can develop without any risk factor. This is called “idiopathic AVN.”

What Are the First Symptoms of Avascular Necrosis?

In the early period of the disease there may be no obvious complaint. As blood circulation continues to be disrupted, symptoms appear gradually.

The most common symptoms are:

• Deep pain in the groin
• Dull or stabbing pain in the hip
• Pain radiating to the front of the thigh
• Pain that increases on long walks
• Difficulty climbing stairs
• Discomfort after standing for a long time
• A feeling of stiffness in the hip during movement

Pain that is felt only during movement at first can later also be present at rest.

How Is the Pain Felt?

The character of pain in AVN can differ from person to person. Patients often describe the pain as:

• A deep pressure sensation in the groin
• Stabbing inside the hip
• Sharp, stabbing pain
• Pain that increases with movement
• Pain that wakes them from sleep at night
• Difficulty standing up

In advanced stages, pain can seriously limit daily activities.

What Happens as the Disease Progresses?

Untreated avascular necrosis can over time cause collapse of bone tissue. In advanced disease the following problems may be seen:

• Clear limitation of hip motion
• Limping
• Inability to fully bear weight on the leg
• Decrease in muscle strength
• Damage to joint cartilage
• Hip osteoarthritis

At this stage the need for surgical treatment may increase.

How Is Avascular Necrosis Diagnosed?

The diagnostic process starts with a detailed history and physical examination. During examination the doctor:

• Assesses the location of pain.
• Examines hip range of motion.
• Observes walking pattern.
• Assesses muscle strength.

Imaging methods are used to confirm the diagnosis.

X-ray

It can show changes in bone structure in later stages of the disease. In the early period, however, it may look normal.

Magnetic Resonance Imaging (MRI)

It is one of the most valuable imaging methods for early diagnosis. Impaired circulation and loss of vitality in the bone can be detected before collapse occurs.

Computed Tomography (CT)

It can be used to evaluate structural changes in the bone in detail.

How Is Avascular Necrosis Treated?

The treatment plan is determined according to the stage of disease, the patient’s age, and whether the bone has collapsed.

Medication

In the early period, some medications may be used to control pain. Medication alone, however, does not completely eliminate the disease.

Load Reduction

A crutch or cane may be used on a doctor’s advice to reduce the load on the hip.

Physical Therapy

Exercise programs aimed at preserving muscle strength and increasing joint range of motion may be used.

Core Decompression (Reducing Pressure Inside the Bone)

This is one of the surgical methods used in the early stage. Pressure inside the bone is reduced in an effort to support new vessel formation.

Bone Graft Procedures

In some patients a bone graft may be used to support weakened bone tissue.

Hip Replacement

In patients with advanced collapse and joint damage, hip replacement surgery may be one of the most effective treatment options.

What Happens If Treatment Is Delayed?

Avascular necrosis is a progressive disease. If it is not diagnosed early:

• Collapse of the femoral head can develop.
• The hip joint can deteriorate.
• Permanent limitation of motion can occur.
• Quality of life can decline because of severe pain.
• The need for hip replacement can arise before older age.

For this reason, early evaluation of unexplained hip pain at a young age is very important.

Can Avascular Necrosis Be Prevented?

It is not possible to prevent every case, but controlling risk factors can reduce the likelihood of disease.

For this:

• Corticosteroid medications should be used only on a doctor’s advice.
• Excessive alcohol use should be avoided.
• Regular exercise should be done.
• A healthy weight should be maintained.
• Early evaluation after hip trauma should not be neglected.
• Patients in risk groups should not skip regular check-ups.

When Should You See a Doctor?

Seeing an orthopedic specialist is recommended if any of the following is present:

• Hip pain lasting longer than three weeks
• Pain radiating to the groin
• Symptoms that do not go away despite rest
• Pain that wakes you from sleep at night
• Limping
• Limited motion
• Difficulty putting weight on the hip
• A history of corticosteroid use or hip trauma

With evaluation in the early period, treatment can be planned before the disease progresses.

Conclusion

Hip pain that starts at a young age and does not go away for a long time should not be regarded as simple muscle strain. Avascular necrosis is an important orthopedic disease that can lead to irreversible damage in the hip joint if it is not recognized early.

If you have symptoms such as pain radiating to the groin, difficulty walking, limited motion, or night pain, it is important to see an orthopedics and traumatology specialist without delay. With early diagnosis, the joint can be protected, appropriate treatment options can be planned, and permanent damage that might develop later can be prevented.