Avascular necrosis of the femoral head occurs in a significant amount of younger patients and several theories exist regarding the aetiology of non-traumatic cases. It is well described in alcoholics as well as patients on corticosteroids and those with sickle cell disease. Traumatic causes such as displaced fractures and hip dislocations may also cause avascular necrosis. The rarer non-traumatic causes include conditions such as rheumatoid arthritis, SLE, chronic pancreatitis inflammatory bowel disease, myeloproliferative disorders and radiation treatment.
Initial examination may reveal nothing more than intermittent dull groin pain with a normal hip range of motion. Early x-rays may also be normal or exhibit only very subtle changes. Once the disease becomes radiologically obvious with femoral head collapse and subchondral fracture, the patients usually present with significant groin pain and hip stiffness.
While management of the early stages of the disease (usually requires MRI diagnosis) with procedures such as core decompression with or without vascularised or non-vascularised structural bone grafting has been described, the benefits of this remain controversial. Later stages of the disease will require total hip arthroplasty.
