• Also known as osteonecrosis or aseptic necrosis.
  • Condition where the blood flow to an area of bone is compromised.
  • Avascular necrosis causes deformation of the bone.
  • Leads to secondary osteoarthritis a few years later.
  • Thus causing painful limitation of joint movement.
Common sites:



  Head of the femur (m/c)
  • Fracture neck of the femur.
  • Posterior dislocation of the hip
  Proximal pole of scaphoid
  • Fracture through the waist of the scaphoid
  Body of the talus
  • Fracture through neck of the talus
Causes of AVN

  • Steroids
  • Alcohol
  • Sickle cell disease
  • Trauma

Symptoms of AVN

  • Pain, often in the groin or buttock
  • Stiffness of the hip joint


Radiological changes:

  1. Sclerosis of necrotic area
  2. Deformity of the bone-because of the collapse of necrotic bone
  3. Osteoarthritis- giving rise to diminished joint space, osteophytes 

Bone scan:
  • Visible as ‘cold area’ on the bone scan.
  • Depending on multiple contributing factors, AVN can be treated with or without surgery.

Conservative (non-operative)

  • Observation
  • Restricted weight bearing
  • Anti-inflammatory medications
  • Bisphosphonates
Surgical treatment

  • Core decompression
  • Hip replacement

Exam Important

  • Avascular necrosis is commoner in Head of the femur.
  • Best diagnostic modality to diagnose avascular necrosis is MRI scan.
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