Q. MRI showed stage 1 AVN in both hips in different angles. Do I need hip replacement?

Answered by
Dr. Shakti A. Goel
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Mar 16, 2020

Hello doctor,

I was diagnosed with minimal change disease before a few months and started on Prednisone. I was into remission within a week but the disease relapsed while on the full dose. Cyclosporine was added and steroids were tapered to 0 within six months. Recently, last month I had an injury during a MMA (mixed martial arts) fight and since I was to run a 5k military obstacle marathon in the coming week I decided to consult a doctor. The consultant was a third year PG who was my sister's senior in medical college. While there was not any signs of injury he noticed changes of avn in left femoral head. I had an MRI the same day that showed stage 1 avn with kerboul angle of 205 in the right hip and stage 2 with angle 170 in the left.

I recently underwent core decompression in bilateral hips. What are the chances of the disease reversing its course? And if I do require a hip replacement will I be able to do high impact activities with it? I am really worried since I am only 23 years old. I have uploaded my post core decompression x-ray. What are the chances of prognosis in my condition?

Dr. Shakti A. Goel

Orthopedics And Traumatology


Welcome to icliniq.com.

AVN (avascular necrosis) of the hip is usually due to a number of causes. Prolonged steroid intake is one of them. The treatment of AVN hips ranges from rest, core decompression and eventually hip replacement. Since you have had stage 1 and 2 in your respective hips, core decompression was a good choice.

This procedure involves drilling one larger hole or several smaller holes into the femoral head to relieve pressure in the bone and create channels for new blood vessels to nourish the affected areas of the hip.

When osteonecrosis of the hip is diagnosed early, core decompression is sometimes successful in preventing the collapse of the femoral head and the development of arthritis.

Core decompression is often combined with bone and cartilage grafting to help regenerate healthy bone and support cartilage at the hip joint. A bone graft is a healthy bone tissue that is transplanted to an area of the body where it is needed. The tissue may be taken from a donor (allograft) or from another bone in your body (autograft).

Core decompression prevents osteonecrosis from progressing to severe arthritis and the need for hip replacement in some cases. Your x-ray does not appear too bad and I am hopeful that core decompression could help in reversal.

I hope this helps.

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