Hip & thigh Orthopaedic Rehabilitation
Avascular Necrosis
- Deep groin pain, worse on weight-bearing
- Pain at rest in later stages
- Progressive loss of hip movement
- A limp
Quick answer
Avascular necrosis is death of bone tissue caused by loss of its blood supply, most often affecting the hip. It causes deep groin pain that worsens with weight-bearing. Physiotherapy maintains movement and strength and manages load, but it does not reverse the bone changes — early orthopaedic assessment is essential.
Typical recovery
Long-term management; depends on stage
Avascular necrosis, also called osteonecrosis, occurs when the blood supply to a section of bone is interrupted and the bone tissue dies. The femoral head — the ball of the hip — is the most common site. Over time the weakened bone can collapse, and the joint surface deforms.
Why early diagnosis matters more here than in most conditions
Treatment options depend heavily on stage. Before the bone collapses, procedures aimed at preserving the joint are possible. After collapse, joint replacement becomes the realistic option. That makes this a condition where a physiotherapist's most valuable action can be recognising it and referring on quickly.
What it feels like
Deep pain in the groin, sometimes referred to the thigh or knee, worse on weight-bearing and progressively present at rest. Hip movement — particularly rotation — reduces. A limp develops.
Risk factors
Long-term corticosteroid use, significant alcohol intake, sickle cell disease, previous hip fracture or dislocation, and decompression sickness. Sometimes no cause is identified.
What physiotherapy can and cannot do
It cannot restore the blood supply or reverse the bone changes. Anyone claiming otherwise should be treated with suspicion.
What it does contribute:
- Maintaining hip range and preventing the secondary stiffness that makes later surgery harder
- Strengthening the muscles around the hip to support the joint
- Managing load — walking aids, activity pacing, weight management
- Full rehabilitation after joint-preserving surgery or hip replacement
How long it takes
This is managed over the long term rather than resolved. Where hip replacement follows, rehabilitation runs three to six months.
Medically reviewed by Nasir Mughees, BPT, MPT, Orthopaedic Physiotherapy · Last reviewed September 2026