Osteonecrosis of the femoral head

Clinical context

What you should know

Associated factors may include prolonged or high-dose corticosteroid treatment, heavy alcohol consumption, hip trauma and certain haematological or autoimmune diseases. In some cases, no cause is identified.

Progression cannot be estimated from pain intensity alone. The size and position of the affected area, the presence of collapse and the condition of the cartilage influence prognosis and treatment options.

First step

Consultation and assessment

Radiographs show the shape of the femoral head and any collapse, but may be normal early on. MRI is the most sensitive test when clinical suspicion persists and helps determine the stage.

The consultation reviews risk factors, current medication, symptoms in the other hip and functional goals. Additional tests are selected according to the clinical context rather than ordered as a standard set for every patient.

Prepare for your consultation

Stepwise treatment

Options are chosen according to the diagnosis and treatment goal

Conservative treatment

• reducing load and modifying activity to control symptoms, without promising to stop progression
• addressing modifiable factors together with the clinicians managing the underlying condition
• pain relief and exercises that preserve movement, tailored to the stage
• clinical and imaging follow-up when observation is the chosen strategy

Medication, injections and devices each have their own indications and contraindications. They are not recommended automatically and do not replace a diagnosis or monitoring of the response.

When surgery is considered

Before collapse, procedures to preserve the femoral head may be considered according to the size and location of the lesion. After collapse and the development of secondary osteoarthritis, total hip replacement often becomes the relevant reconstructive option.