How effective is physiotherapy for avascular necrosis of the hip?

Avascular necrosis, also called osteonecrosis, involves reduced blood supply to the femoral head. Pain, limited hip movement and difficulty walking may develop as the condition changes. Physiotherapy can help you use the hip safely, maintain strength in the buttocks and thighs, improve balance and adapt daily activities. Your therapist may recommend load-management strategies or an aid for walking. The right programme depends on the stage of the condition, pain level, imaging findings and whether the hip surface remains stable. It cannot reverse bone damage or delay every case from progressing, so orthopaedic follow-up remains essential.

Begin with an assessment of walking, hip range, strength and the activities that increase load. Follow weight-bearing instructions from your orthopaedic team; do not add impact exercise or heavy resistance without clearance. Low-impact movement, carefully dosed strengthening and practical advice about stairs, sitting and work may be useful. Tell the therapist if pain lingers after exercise, your limp increases or an aid feels unsafe. A change in symptoms may require reassessment rather than simply more exercise.

Contact your orthopaedic clinician if hip pain becomes more frequent, walking distance falls, or the leg feels less stable. Seek urgent assessment after a fall with severe pain or inability to bear weight. New fever with a hot, swollen joint, sudden marked weakness or severe pain at rest also warrants prompt medical attention.

How much weight can my hip safely take? Do I need a walking aid? Which exercises fit the stage of my condition? What change in pain or walking should lead to repeat imaging or an earlier review?