Episode Summary
Learn how to spot avascular necrosis of the hip early by recognizing key risk factors, clinical clues, and imaging findings before joint collapse occurs. Amy Coombs also highlights why sharp clinical reasoning and timely referral can dramatically change outcomes for patients with hip pain.
Avascular necrosis of the hip is explained as bone death in the femoral head caused by disrupted blood supply, with emphasis on why early recognition matters. The teaching covers the hip’s vulnerable vascular anatomy, the difference between traumatic and atraumatic causes, and the main risk factors that should raise suspicion, including fractures, dislocation, alcohol misuse, corticosteroid use, autoimmune disease, sickle cell disease, smoking, obesity, diabetes, and possible post-COVID clotting risk.
Learners are guided through typical presentation, such as C-sign groin pain, pain radiating to the knee, night pain, weight-bearing difficulty, gait changes, clunking, and reduced hip movement. It also highlights less obvious cases, including patients presenting mainly with knee pain or having early disease despite near-normal movement.
Imaging interpretation is a major focus, including when plain X-rays may appear normal, when MRI is needed, and how to recognise subchondral cysts, crescent sign, femoral head flattening, and ARCO staging. The summary of management includes urgent orthopedic referral, conservative options in early disease, surgical pathways in later disease, and the risks of rapid joint collapse after intra-articular steroid injection in selected patients.
