Total Hip Replacement (THR) & AVN Surgical Second Opinion

AVN occurs when blood supply to the ball of the hip joint (femoral head) is disrupted, causing bone cells to die. In early stages (Stage 1 and 2, before the spherical surface collapses), joint-preserving treatments like core decompression with bone marrow aspirate concentrate (BMAC) can save the natural hip. Once the femoral head collapses (Stage 3 and 4), total hip replacement is the definitive treatment.

Common triggers include excessive alcohol intake, high-dose or prolonged corticosteroid use (including post-COVID steroid regimens), sickle cell disease, and prior hip trauma or dislocation. In many cases, it is idiopathic (spontaneous).

A frog-leg lateral X-ray and 1.5T/3.0T MRI detect the crescent sign (subchondral fracture) indicating femoral head flattening or collapse. Our panel examines raw MRI cross-sections to verify exact stage and collapse percentage.

In Ficat-Arlet Stage 1 and early Stage 2 (where the femoral head remains perfectly spherical and necrotic involvement is less than 30%), core decompression reduces intraosseous bone pressure and stimulates revascularization, succeeding in delaying or avoiding replacement in 70–80% of patients.

Ceramic-on-ceramic (Delta ceramic) or ceramic-on-crosslinked-polyethylene bearings produce negligible wear debris. Clinical registries demonstrate survivorship rates exceeding 95% at 20–25 years, making it an excellent solution even for patients in their 20s, 30s, and 40s.

High-impact contact sports (rugby, sprinting, heavy jumping) are discouraged to prevent dislocation or premature implant loosening. However, low-to-moderate impact activities like swimming, cycling, golf, brisk walking, treadmill workouts, and doubles tennis are fully encouraged.

The direct anterior approach enters between muscles without detaching them from the bone, offering faster immediate mobilization and lower dislocation risk in the first 6 weeks. The posterior approach is the most widely performed worldwide, providing excellent exposure for complex anatomies with identical long-term outcomes after 3 months.

Complications are rare (<2%) and include hip dislocation (1%), leg length discrepancy (usually within 2–5 mm to stabilize soft tissues), deep infection (<1%), and DVT blood clots.

Restoring anatomical leg length and hip offset is a primary surgical goal. Due to pre-existing pelvic tilt and joint stiffness, the operated leg may temporarily feel slightly longer for 6–8 weeks until pelvic muscles rebalance.

Patients walk with a walker on day 1, transition to a walking stick within 10 to 14 days, and walk independently by week 4. Full soft-tissue recovery takes 3 months. Hip replacement recovery is generally faster and less painful than knee replacement.

Unilateral total hip replacement using premium uncemented titanium stems and ceramic bearings ranges from ₹1,90,000 to ₹3,20,000 in Pune.

Yes. In young, medically fit patients with bilateral Stage 3/4 AVN, simultaneous bilateral hip replacement under a single spinal anesthesia is safe, reduces overall hospital stay, and eliminates unequal leg lengths during recovery.

Stem cells or PRP injected into a collapsed femoral head (Stage 3 or 4) cannot regrow dead bone or restore joint sphericity; clinical trials show no reversal in advanced stages. Beware of clinics marketing stem cell cures for collapsed AVN.

Staging errors are common. Many patients diagnosed with early AVN on basic X-rays are rushed into hip replacement when core decompression could have preserved their natural joint for decades. Our panel provides rigorous staging verification.

Submit digital X-rays (Pelvis with both hips AP view and Frog-Leg lateral views) and high-resolution MRI scans (T1 and T2 coronal and sagittal DICOM images or clear film photos) along with blood inflammatory markers.