What are the key clinical features and risk factors to consider when diagnosing avascular necrosis in a patient?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 22 August 2025Updated: 22 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

When diagnosing avascular necrosis (AVN), key clinical features often include pain, particularly in the groin, buttock, or knee, which is typically aggravated by activity and relieved by rest . Patients may also present with a limited range of motion, especially affecting internal rotation and abduction of the hip .

Several significant risk factors should be considered. These include the use of glucocorticoids, particularly high-dose and long-duration therapy, and chronic alcohol abuse . Systemic lupus erythematosus (SLE) is a notable risk factor, as are other autoimmune diseases . Other important risk factors include trauma, hyperlipidemia, coagulation disorders, and Gaucher disease . Additionally, older age and male sex have been identified as risk factors .

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