When Is Osteotomy Recommended for Avascular Necrosis of the Hip?

Avascular necrosis reduces the blood supply to the femoral head. As the affected area weakens, weight-bearing can cause collapse and lead to painful arthritis. An osteotomy cuts and realigns bone so a healthier part of the femoral head carries more load. It is considered only after examination and imaging show that the joint shape, damaged area and remaining bone make realignment reasonable.

The procedure is less suitable when the femoral head has already collapsed substantially, the joint has advanced arthritis, or pain and loss of movement are mainly coming from widespread joint damage. Other options may include protected weight-bearing, medicines for symptoms, procedures aimed at preserving the femoral head, or joint replacement, depending on the findings.

Arrange an assessment with an orthopaedic surgeon familiar with hip-preserving procedures. Bring previous scans and a list of medicines, steroid exposure, alcohol use and medical conditions, because these can help explain the cause and influence planning. Until reviewed, follow any weight-bearing advice and use an agreed walking aid rather than pushing through worsening hip pain.

Ask how much of the femoral head is affected, whether collapse is present, and what recovery would involve. Rehabilitation commonly focuses on protected movement, gradual strengthening and a staged return to loading.

Seek prompt medical care for sudden severe hip pain, inability to stand or walk, a new leg-length difference, fever with a hot or swollen joint, or pain after a fall. These features can signal collapse, fracture or infection and need assessment rather than routine follow-up.

Is the femoral head still suitable for a joint-preserving osteotomy? Which imaging findings support or oppose it? What alternatives fit my stage of disease, and how would each affect walking, rehabilitation and future hip surgery?