What is it about?
Avascular necrosis (AVN) of the femoral head is a rare but serious cause of hip pain, often presenting with non-specific symptoms that can be mistaken for more common musculoskeletal conditions. We report the case of a 65-year-old Asian male, a retired taxi driver without traditional AVN risk factors, who presented with a three-month history of progressive right hip pain - characterized as a dull, constant ache that sharpened during weight-bearing activities - and associated limping. Clinical examination revealed antalgic gait, restricted hip range of motion, and positive orthopedic tests, prompting imaging that confirmed AVN with subchondral collapse. Conservative management involving manual therapy, joint mobilization, and exercise offered only temporary symptomatic relief, and the patient eventually required total hip replacement. This case underscores the importance of careful assessment, early imaging, and multidisciplinary collaboration in managing persistent hip pain, while also highlighting the need for musculoskeletal clinicians to be vigilant for vascular pathologies and rare conditions such as AVN, particularly in older adults and those with chronic inflammatory disorders.
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Why is it important?
Because early stages of AVN frequently mimic benign mechanical hip conditions, patients often first present to primary-contact musculoskeletal providers [6,7]. This case highlights the clinical presentation of idiopathic AVN in a 65-year-old male, underscoring the vital need for clinicians to recognize key diagnostic "red flags" - including progressive antalgic gait, severe restrictions in hip range of motion (ROM), and positive intra-articular orthopedic tests. Documenting such atypical presentations is critical to addressing the literature gap, enhancing diagnostic vigilance, and fostering timely multidisciplinary care.
Perspectives
Avascular necrosis (AVN) of the femoral head is a debilitating disorder resulting from compromised blood supply to the proximal femur, leading to progressive bone death and joint collapse if left untreated [1]. The femoral head is uniquely vulnerable to ischemia because it relies heavily on a limited network of terminal arteries - predominantly the circumflex femoral arteries - with minimal collateral circulation [2]. While over 80% of non-traumatic cases are secondary to well-known risk factors such as chronic steroid use or excessive alcohol consumption, AVN can also arise idiopathically [3]. Its occurrence in older adults without traditional predisposing conditions is exceedingly rare and poorly documented in current medical literature, presenting a significant diagnostic gap [4,5].
Dr Eric Chun-Pu Chu 朱君璞
New York Medical Group
Read the Original
This page is a summary of: Idiopathic Avascular Necrosis of the Femoral Head in an Older Adult: A Case Report, Cureus, July 2026, Springer Science + Business Media,
DOI: 10.7759/cureus.112084.
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