At times total hip replacements are not done for osteoarthritis. We had a young patient recently who had sustained a right pelvic fracture in a motor vehicle accident. He was having excruciating pain in his hip. His pelvic fracture had healed great but he had lost the blood supply to his femoral head and had developed Avascular Necrosis. As the name implies, this means that due to loss of blood supply, the femoral head actually starts to die. As you know, our bones are alive and require a steady source of blood to allow bone turnover and nutrients. If this is lost, the bone will not be viable. This is extremely painful for the patient.
If the diagnosis is in question, an MRI can be obtained of the hip. As you can see in this image, the femur is gray but the top of the femur has actually turned dark, consistent with loss of blood supply.
Although this patient was quite young, once the avascular necrosis gets to the point of changing the shape of the femoral head, the main surgical option is to do a total hip replacement.
We saw him back recently and he is able to do stairs without pain and is weaning off his walker for the first time in years. He is hoping to be able to start working again soon.