Avascular Necrosis Of The Bilateral Hips
Avascular necrosis (AVN) of the bilateral hips, also known as osteonecrosis, is a condition where bone tissue in both hip joints dies due to insufficient blood supply. This progressive disorder can lead to bone collapse and severe arthritis if left untreated, causing significant pain and disability in both hips simultaneously.
What is it?
Avascular necrosis of the bilateral hips occurs when blood flow to the femoral head (the ball of the hip joint) in both hips is disrupted, causing bone cells to die. Without adequate blood supply, the bone begins to break down and eventually collapses. The bilateral nature means both hips are affected simultaneously or in close succession, which significantly impacts a patient’s mobility and quality of life. The femoral head is particularly vulnerable because it relies on a limited number of blood vessels for its blood supply.
AVN affects approximately 10,000-20,000 people annually in the United States, with 40-80% of AVN cases involving both hips. It most commonly affects people between ages 30-50 and occurs more frequently in men. Risk factors include long-term corticosteroid use, excessive alcohol consumption, trauma, certain medical conditions (sickle cell disease, lupus, HIV), chemotherapy, radiation therapy, and diving-related decompression sickness. In some cases, no clear cause can be identified (idiopathic). The condition progresses through distinct stages, from early changes visible only on MRI to late-stage collapse requiring joint replacement.
Important to Know
Early detection and treatment of bilateral hip AVN is crucial to preserve the hip joints and prevent collapse. In early stages, treatments such as medications to improve bone density, core decompression surgery (drilling into the bone to relieve pressure and stimulate new blood vessel growth), or bone grafting may help preserve the femoral head. However, once significant collapse has occurred, total hip replacement is often necessary. Because both hips are affected, treatment planning becomes more complex and may involve staged surgeries. Physical therapy, weight management, and avoiding risk factors like alcohol and smoking are important supportive measures. Regular monitoring with imaging is essential to track disease progression and adjust treatment accordingly.