Avascular Necrosis: Causes, Symptoms, and Treatment
Medically reviewed by Achuta Uppu, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Avascular Necrosis?
An orthopedic surgeon, a doctor who treats bone and joint problems, usually manages avascular necrosis. A primary care doctor can start the evaluation and order the first imaging tests. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is avascular necrosis?
Avascular necrosis, also called osteonecrosis, is bone death caused by poor blood supply. Bone cells need a steady supply of blood to stay healthy. When part of a bone does not get blood flow, the bone dies. After a while, the bone can collapse.
If the bone collapses, the nearby joint breaks down too, which can lead to severe arthritis. The condition is most common in the hip and shoulder. It can also affect other large joints such as the knee, elbow, wrist, and ankle. It usually strikes people in their thirties, forties, or fifties.
Symptoms
There are no symptoms in the early stages. As bone damage worsens, you may have:
- Pain in the joint that gets worse over time.
- Pain that occurs even at rest.
- Limited range of motion when the joint collapses.
- Groin pain, if the hip joint is affected.
- Limping, if the condition occurs in the leg.
- Trouble with overhead movement, if the shoulder is affected.
As the disease gets worse, you will probably have joint pain that becomes more severe. You may not be able to bend or move the affected joint very well.
Causes and who gets it
It is not always known what causes the lack of blood supply. Possible causes include:
- Injury, such as a dislocation or fracture around a joint, that damages the blood vessels.
- Long-term or high-dose steroid medicines.
- Excessive alcohol use.
- Sickle cell disease and other blood conditions that cause abnormal clotting.
- Radiation therapy or chemotherapy.
- Diseases such as Gaucher disease and lupus.
Sometimes it occurs without any known cause, which doctors call idiopathic.
How doctors diagnose it
The doctor will examine the joint, ask about your symptoms, and review your medical history. After the exam, you may get one or more imaging tests. A bone scan or CT scan may also be used.
Treatment
Treatment depends on the stage of the disease. If it is caught early, you may take pain relievers, limit use of the joint, use crutches to take weight off it, and do range-of-motion exercises. Nonsurgical care can often slow the disease, but most people will eventually need surgery.
Surgical options include core decompression, which removes part of the inside of the bone to relieve pressure and let new blood vessels form. Others are a bone graft, an osteotomy (cutting the bone to change its alignment), and partial or total joint replacement.
When to see a doctor
Contact your doctor if you have lasting joint pain, groin pain, or a limp that does not go away.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. Either can arrange the first imaging tests, follow your pain and mobility over time, and coordinate referrals to an orthopedic surgeon when surgery becomes an option.
Common questions
Is avascular necrosis the same as osteonecrosis?
Yes. Avascular necrosis, osteonecrosis, and aseptic necrosis are different names for the same condition: bone death caused by poor blood supply.
Which joint does it affect most often?
The hip. Osteonecrosis is most common in the hip and shoulder. It can also affect other large joints such as the knee, elbow, wrist, and ankle.
Can it heal without surgery?
Usually not. Nonsurgical treatment can often slow the progression, but most people will eventually need surgery. Surgical choices include core decompression, bone grafts, and joint replacement.
Can avascular necrosis be prevented?
Often no, because many cases have no known cause. You can lower your risk by avoiding excessive alcohol and, when possible, avoiding high doses and long-term use of corticosteroids.
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Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
