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 MSt MRCGP.

Posted: 22 August 2025Updated: 22 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed

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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