If hip pain or discomfort caused by avascular necrosis (AVN) does not improve with non-operative treatment, or if your doctor is concerned about further collapse of the ball and worsening of your child’s condition, surgery for AVN may be recommended.

Surgery can include the following methods:

Autologous bone marrow grafting and core decompression

In this procedure, the surgeon drills one larger or several smaller holes into the areas of dead bone to relieve the internal bone pressure (core decompression) and allow blood flow into the hip. Then the surgeon injects healthy bone marrow taken from another part of the patient’s body (autologous bone marrow grafting) into the diseased hip bone to help it heal. In some cases, the surgeon will place a small piece of bone into a larger opening in the hip to provide extra support and help the bone heal.

Free vascularized fibular grafting

For patients with large areas of the hip that aren’t getting blood flow but haven’t collapsed yet, free vascularized fibular grafting (FVFG) is a more involved procedure that can bring healthy blood flow back to the hip more quickly. 

In a FVFG procedure, dead bone at the hip is replaced with live, healthy bone from the lower leg (fibula) that has its own blood supply. Blood vessels from the living bone are attached to those around the hip to provide immediate blood supply. FVFG is performed by a team that includes plastic surgeons with expertise in microsurgery, a technique used to reconnect small blood vessels.

Total hip replacement

For patients whose ball has collapsed, which often causes pain and stiffness, the hip may no longer be able to be saved. In these situations, total hip replacement can provide excellent pain relief and help patients return to a high level of function. During the procedure, the damaged ball and socket of the hip are replaced with artificial parts made of metal, plastic or other durable materials. 

After surgery, most patients can put their full weight on the hip and get back to their normal routines within a few weeks, although certain strenuous activities may not be recommended.

CHOP’s areas of expertise and care for avascular necrosis

As one of the largest and most experienced pediatric hip programs in the country, the Hip Disorders Program within Children’s Hospital of Philadelphia’s (CHOP) Orthopedic Center, provides specialized care for a wide range of hip conditions. Whether treating congenital disorders or conditions that develop later in childhood, CHOP delivers patient-centered care, tailored to each child’s needs, as well as to teens and young adults who are treated through the Young Adult Hip Preservation Program.