When hip pain slows you down, everyday activities can feel like a struggle. If stiffness, discomfort, or limited movement is holding you back, hip necrosis may be to blame.Â
Dr. Alexander McLawhorn is a recognized expert in hip replacement and joint preservation in New York City and Stamford, Connecticut. As one of the nation’s most experienced surgeons in robot-assisted hip replacement, he performs over 600 joint procedures each year using the latest techniques to improve long-term function.
What Is Hip Necrosis?
Hip necrosis, also called avascular necrosis or osteonecrosis, happens when the bone in the hip joint loses its blood supply. Without blood, the bone at the top of the thigh (femur) can weaken and die. Over time, this can lead to the bone breaking down and the hip joint collapsing. People with hip necrosis may experience pain, stiffness, and trouble moving their hip.
What Causes Hip Necrosis?
Several factors can lead to hip necrosis. Here are some common causes:
- Unknown causes (Idiopathic):Â In many cases, doctors cannot pinpoint the exact reason why hip necrosis develops.
- Injury:Â A broken or dislocated hip can disrupt blood flow, increasing the risk of necrosis.
- Heavy alcohol use:Â Drinking too much alcohol can cause fatty deposits to build up in blood vessels, reducing blood flow to the hip.
- Steroid medications:Â Corticosteroids, often used for conditions like arthritis or as part of cancer treatments, can affect blood vessels and contribute to bone damage.
- Medical conditions:Â Certain health problems, like blood clotting disorders, vasculitis, or HIV, can increase the risk.
- Radiation therapy:Â Radiation in the pelvic area can weaken bones and lead to hip necrosis.
Understanding the causes may help some people lower their risk, though not all cases can be prevented.
How Is Hip Necrosis Treated?
Treatment depends on how far the condition has progressed, how much damage has occurred, and your state of health. Some options include:
- Medications:Â Anti-inflammatory drugs or pain relievers can help manage symptoms. Some studies suggest that bisphosphonates may slow bone damage in the early stages.
- Physical therapy:Â Strengthening the hip muscles and improving mobility may help reduce pain and keep the joint functioning as long as possible.
- Core decompression:Â This surgical procedure involves drilling small holes in the bone to relieve pressure and encourage new blood vessel growth. It is most effective in early-stage hip necrosis.
- Bone grafting:Â If a large section of bone is affected, a bone graft may be used along with core decompression to help rebuild the damaged area.
- Osteotomy:Â This surgery realigns the hip joint to shift weight away from the damaged bone, reducing stress on the affected area.
- Hip replacement: If the bone has collapsed, a total hip replacement is usually the best option to restore movement and relieve pain.
Dr. McLawhorn, a hip and knee specialist at Hospital for Special Surgery, will discuss these treatment options in detail during your visit. A full medical history is important to determine the best approach for your specific condition.
Stages of Avascular Necrosis
Hip necrosis develops gradually, and the severity depends on how much damage has occurred. The condition is typically divided into four stages:
- Early stage (Stage 1):Â Blood flow to the bone is reduced, but the bone still looks normal on X-rays. Some people may have mild pain, while others have no symptoms at all.
- Intermediate stage (Stage 2):Â The bone starts to weaken, and X-rays may show early signs of damage. Pain and stiffness become more noticeable.
- Advanced stage (Stage 3):Â The bone begins to collapse, causing significant pain and limited movement. The hip joint may start to lose its shape.
- Severe stage (Stage 4):Â The bone has completely collapsed, and the surrounding cartilage is damaged, leading to arthritis. At this point, a hip replacement is usually needed.
Why Choose Dr. Alexander McLawhorn?
Dr. Alexander McLawhorn is more than an experienced orthopedic surgeon. He is a leader in the field of hip and knee replacement. As the top joint replacement surgeon at Hospital for Special Surgery (HSS) by volume and experience in New York State, he has performed thousands of procedures using robotic-assisted techniques. He is among the most experienced surgeons in robot-assisted direct anterior hip replacement. His expertise extends to hip resurfacing, the "bikini incision" approach for total hip replacement, and rapid-recovery joint replacement.
Beyond surgery, Dr. McLawhorn is actively shaping the future of joint replacement. As the Director of Research and Innovation for the Adult Reconstruction and Joint Replacement Service at HSS, he has authored numerous publications and received multiple research awards, including the prestigious Frank Stinchfield Award from the Hip Society.Â
Dr. McLawhorn provides world-class orthopedic care to local, national, and international patients seeking the best possible treatment for hip conditions.
Frequently Asked Questions
What Happens if Hip Necrosis Is Left Untreated?
Without treatment, hip necrosis worsens over time. The bone may collapse, causing severe pain, stiffness, and difficulty walking. As the joint deteriorates, arthritis can develop, making movement even harder. Early treatment can help preserve the hip and delay or prevent major surgery.
Does Avascular Necrosis Always Require Surgery?
Not always. If caught early, medications, physical therapy, or core decompression may slow progression and relieve pain. However, if the bone collapses or the joint is severely damaged, surgery – such as hip replacement – may be the best option for lasting relief.
How Long Does It Take for Avascular Necrosis to Progress?
AVN can worsen over months or take years to progress, depending on the cause and overall health. Early stages may have mild symptoms, but without treatment, the bone can collapse, leading to severe pain and joint damage.
How Long Will It Take to Recover from Surgery?
Recovery depends on the procedure. Core decompression takes about six to 12 weeks, while hip resurfacing and total hip replacement require six to 12 weeks for daily activities and several months for full recovery. Dr. McLawhorn’s robot-assisted and minimally invasive techniques help improve recovery time and mobility.
Trusted Orthopedic Care in NYC and Stamford
For more information, contact Dr. McLawhorn’s offices in New York (203-659-0048) or Connecticut (917-277-3841). Whether you're in the early stages of hip necrosis or need a joint replacement, Dr. McLawhorn’s advanced surgical techniques offer patients the best possible outcomes.
