You are 26, or 34, with a job, a family and plans — and an MRI says avascular necrosis (AVN) of the hip. Perhaps a surgeon has already said "replacement". At your age that is a heavy word. Here is what you should know first: AVN is a disease of younger adults much more than hip arthritis is, and young bodies have a strong capacity to heal. At AVN Arogya, in the majority of the patients we treat for early-stage AVN, progression is arrested without surgery, and many of our patients who were advised replacement have avoided or deferred it.
Why young adults get avascular necrosis
AVN happens when the blood supply to the ball of the thighbone (the femoral head) is interrupted and part of the bone weakens. It is often diagnosed in adults in their 30s to 50s, younger than most people with hip arthritis. Many of the patients we see with hip AVN are in their 20s, 30s and 40s.
The common causes in young adults are:
- Steroid medicines — the most common cause of AVN in India. Young people take them for asthma, allergies, skin and kidney disease, autoimmune illness, after a transplant, and during severe COVID-19. Read Can steroids cause avascular necrosis?
- Heavy or prolonged alcohol use.
- A hip injury — a fracture or dislocation, for example after a road accident or a sports fall.
- Sickle-cell disease, clotting disorders and lupus.
- Radiation or chemotherapy in the past.
In about one case in five no clear cause is found. That does not mean you did anything wrong.
Why hip pain in a young adult is often missed
Young people are not expected to have serious hip disease, so the first pain is often put down to a sports strain, a back problem or "too much gym". The early signs are groin or hip pain with activity, pain in the knee or thigh with a normal knee, pain at night, and stiffness when turning the leg inwards. An X-ray can be normal in the early stage; an MRI finds AVN before the X-ray changes. If you have any of the causes above and a hip that keeps hurting, ask for an MRI. Our guide to the early signs of AVN explains each sign.
Why a hip replacement at a young age is a hard choice
A hip replacement can relieve pain very well, and when it is truly needed it is the right treatment. But an artificial hip wears with time, and the younger and more active you are, the more likely it is that you will need a second operation (a revision) later in life. That is one reason why you need to try and preserve your own hip whenever possible.
Conventional options to preserve the hip, such as core decompression, are mainly used before the bone has collapsed. We explain it in Core decompression for AVN. However, the results are not always satisfactory, and many cases progress towards collapse and the need for replacement. Ayurveda offers a further way to protect the hip by strengthening the body's own ability to heal the bone.
How Ayurveda helps young adults with AVN at AVN Arogya
AVN is our flagship speciality. Our treatment works to reduce inflammation, improve blood flow to the bone, strengthen the bone by supporting bone metabolism, and remove whatever gets in the way of the body's own healing. We begin with the cause — a detailed history and a panel of blood tests — so that each contributing factor can be addressed.
The first course is an inpatient programme, usually 21 days and occasionally extended to 28, followed by outpatient care; even mild AVN needs this inpatient start. Every programme is designed personally by your physician for your stage, your inflammatory state, your age and your life; it is not a fixed protocol. It brings together our own Ayurvedic medicines, made in-house and tested to international standards for heavy metals; classical therapies chosen for you, such as Vasti and Kizhis; physiotherapy and supported yoga to strengthen the muscles around the hip without overloading it; and a therapeutic diet.
Then structured follow-up: home medicines, monthly teleconsultations, a repeat MRI at twelve months and an optional ten-fourteen day booster stay each year. For leave from work, we can provide medical certificates and supporting documents for your employer.
What young patients can expect
Many patients have their first real rest without pain within the first days, and most feel meaningful pain reduction within 10 to 14 days of admission. However, pain can be influenced by other factors like inflammation and in cases where it is high it can take longer to feel relief. For stages 3 to 4, walking and daily activities typically improve meaningfully within 3 to 6 months. In the majority of the patients we treat at stages 1 and 2, progression is completely halted; at stage 3, in the majority of the patients we treat, pain and function improve significantly, progress is halted and replacement is avoided. In stage 4 patients, there is very good improvement in pain and recovery of function and patients are able to avoid or delay replacement surgery in majority of cases. Young patients usually return to work and study after their programme.
You can watch patients who were told surgery was the only option describe their recovery in their own words.
When surgery is the right step, even when you are young
We say this plainly. Stage 4 AVN with progressive severe pain and inability to walk, despite a full course of in-patient treatment and faithfully followed followup medication, exercises and lifestyle changes for about 6 months, usually needs a hip replacement, whatever your age. When that is the right path, we recommend it clearly and refer you to orthopaedic surgeons. Choosing surgery then is not giving up; it is the right treatment.
Frequently asked questions
Can I get AVN at 25?
Yes. AVN can occur at any age; in adults it is often found from the 30s onwards, and steroids, alcohol and injury can bring it on earlier.
Can I keep playing sport or going to the gym?
Not as before, for a while. High-impact activity and heavy loading can worsen AVN and speed up damage. Your physician will advise what is safe at your stage, and physiotherapy builds strength without loading the hip. See Is walking good for AVN of the hip?
I took steroids during COVID. Should I get an MRI?
If you took steroids and now have hip or groin pain, or knee pain with a normal knee, ask your doctor for an MRI. Do not stop any prescribed steroid on your own.
Will AVN affect my other hip?
It may. AVN often affects both hips, so the other hip is checked as part of every assessment. Read Bilateral AVN — when both hips are affected.
Seek urgent care if your hip pain suddenly becomes severe, if you suddenly cannot put weight on the leg, or if the hip is hot and swollen with a fever.
For an honest second opinion and a chance to avoid unnecessary surgery, consult an AVN Senior Physician and bring your MRI. Read about Ayurvedic treatment for avascular necrosis at AVN Arogya, or book a consultation — you can send your MRI and reports in advance.