Causes and risk factors of avascular necrosis of the femoral head include:

• May develop on its own from an unknown cause 
• The result of an accident in which the hip joint dislocates, or the hip or pelvis is fractured
• Excessive, prolonged steroid use
• Excessive alcohol consumption
• Certain blood and autoimmune diseases
• Smoking

In the early stages of the condition, patients may not present any symptoms, which eventually will start to show as the condition progresses. Symptoms may include pain in the hip and groin area that may even extend to the knee or buttock of the affected side.

Diagnosing avascular necrosis of the femoral head may involve:

• Physical examination and a review of the patient’s medical history
• X-ray of both hips, as up to 20% of patients suffering from avascular necrosis of the femoral head will have it on both sides
• Magnetic resonance imaging (MRI)

Other than the patient’s symptoms, the test results of an X-ray or MRI will help to differentiate between the condition being mild or severe, as well as help with determining the prognosis. For example, if it’s suspected that there will be changes in bone marrow or pressure in the femoral head that will cause degeneration, treatment can be geared toward the expected outcome.

Treatment options are as follows: 

• Non-surgical treatment, which is suitable in mild cases or if the condition is still in its early stages where the femoral head is not highly damaged. This method is to sustain the joint but is not intended as a complete cure. This route can involve:
  • Walking with the support of a walking aid (canes, walkers)
  • Undergoing physical therapy
  • Taking pain medication or other medications such as anti-coagulation, statins and other cholesterol-lowering, bone regeneration, and hormone medications
• Surgical treatment. This can involve:
  • Core decompression to reduce pressure in the bone
  • Hip replacement, considered when non-surgical options prove unsuccessful, meaning the pain does not subside, or no improvement is seen after rehabilitation

The doctor will determine the most appropriate treatment plan based on each patient’s specific case.