Avascular Necrosis of the Femoral Head (Early-Stage, Adjunct)

Common Symptoms

• Groin or hip pain that can start gradually and worsen over weeks to months
• Pain with weight-bearing, particularly at the extremes of hip motion
• Pain that may initially come and go before becoming more constant
• Reduced hip range of motion as the condition progresses

Why It Happens

Blood flow to a portion of the femoral head is disrupted, most often related to corticosteroid use, heavy alcohol use, certain blood or autoimmune disorders, or trauma, though in some cases no clear cause is identified. Without adequate blood supply, that portion of bone can weaken and eventually collapse.

Why It Can Become Persistent

Bone without adequate blood supply cannot repair itself the way healthy bone can, and if the affected area is large enough or the disease progresses, structural collapse of the joint surface can occur — this is a structural, potentially progressive process, not something that resolves with rest alone.

Who Commonly Gets It

Avascular necrosis of the hip is more common in people using long-term corticosteroids, people with heavy alcohol use, certain blood disorders (such as sickle cell disease) or autoimmune conditions, and after significant hip trauma; it typically affects adults in their 30s to 50s.

How It Is Usually Diagnosed

Diagnosis involves X-ray and, especially for earlier-stage disease, MRI, which is more sensitive for detecting avascular necrosis before it's visible on X-ray. Staging (how much of the bone is affected and whether collapse has occurred) is central to treatment planning.

Traditional Treatment Options

• Activity modification and protected weight-bearing: Reducing load on the joint, particularly in earlier stages.
• Core decompression: A surgical procedure to relieve pressure within the bone, generally used for earlier-stage disease before collapse.
• Bone grafting procedures: Used in select cases to support the affected bone.
• Total hip replacement: The definitive treatment once significant collapse and arthritis have occurred.

Why Someone Might Start Looking for Another Option

Because avascular necrosis can progress to joint collapse, there's real clinical interest in earlier-stage, joint-preserving options — including shockwave therapy — that might help before more invasive treatment becomes necessary.

Where Shockwave Therapy May Fit

Two independent systematic reviews (pooling 9 and 13 studies, respectively) found shockwave therapy improved hip pain and function scores in early-stage osteonecrosis of the femoral head, and one noted that higher-energy protocols were associated with greater benefit, particularly in earlier disease stages. We want to be equally clear about what this evidence does not show: imaging in these reviews did not show a statistically significant reduction in the area of dead bone, and shockwave therapy did not meaningfully change formal disease staging. Read this as evidence for a pain-and-function adjunct in earlier-stage disease, not a way to reverse bone death or avoid surgery when surgery is genuinely indicated.

How Shockwave Treatment Works for This Area

Shockwave therapy would only be considered as part of a coordinated plan with your orthopedic specialist for appropriately staged, earlier disease — never as a stand-alone alternative to specialist evaluation and staging.

What the Treatment Feels Like

Most patients describe a firm tapping or pressure sensation around the hip; your provider will discuss what to expect based on your evaluation.

What Happens During Your First Visit

Your visit begins with a provider evaluation focused on your history and a physical exam relevant to your complaint. If shockwave therapy is determined to be clinically appropriate, your first treatment can typically be provided the same visit. See our What to Expect page for the full walkthrough.

Who May Not Be Appropriate

• Anyone who has not yet been evaluated and staged by an orthopedic specialist
• More advanced disease with bone collapse, where surgical treatment is indicated
• Active infection, open wounds, or certain bone conditions at the treatment site
• Certain circulatory, neurological, or bleeding-related conditions, per your provider's screening

This list is not exhaustive. Your provider will screen for contraindications during your evaluation.