At first, as the blood supply to the bone decreases and bone degeneration starts, there may be no symptoms whatsoever. Most days you are not even aware of anything out of the ordinary and life continues as normal. However standing for long periods becomes uncomfortable and you need to keep shifting your weight from leg to leg. Walking for long distances becomes more difficult as your hip and buttocks ache and become tired. Fortunately, resting helps and your discomfort disappears almost immediately.
Your main symptom is an ache or discomfort, so you can still get a good night’s sleep during this stage. On occasion, you may need over-the-counter pain medication, but in general small lifestyle changes relieve all your symptoms, and the pain is still manageable.
As the necrosis of your hip progresses, you must walk shorter and shorter distances before your pain starts. The pain goes from mild to moderate and interferes with activity. Where the initial pain was only in your groin, it starts spreading to your hip, buttocks, or lower back. At times the pain spreads into your thigh or down to your knee.
Standing periods become shorter and weight shifting to the other side does not offer as much relief anymore. You start looking for places to sit down and rest your hip before standing up again. Some days you won’t want to leave the house without something to lean on, like a walking stick or crutch. Without it, a long walk causes a severe flare-up in your pain. You start anticipating pain and being able to predict which movements is going to make it worse. Hesitating at a “too high” step.
Symptoms progress from a vague discomfort to a continuous ache in your groin, hip, or buttock. Resting still provides pain relief, but it takes longer for the pain to settle and the ache doesn’t really change. Your daily routine starts to change because you need to rest more often and you’ll start to avoid chores or hobbies that make your hip pain worse.
Sleep becomes interrupted as your hip wakes you up when you turn around in bed. Sleeping on the painful hip is limited to short periods and you eventually change your sleeping position, with the help of trusty cushions, you’re able to prop yourself up into a manageable position, as long as you don’t need to get up to go to the bathroom during the night…
At this point, you always have some sort of pain and anti-inflammatory medication nearby to manage the pain. Dependency and reliance on medication strength becomes a problem.
The ache progresses to a constant sharp, stabbing pain in your hip, groin, or buttocks and spreads down your thigh more often.
Walking is only possible when you have something to hold on to, so you will start to use a walking stick or crutches most of the time. Leaning onto a trolley when doing grocery shopping is a must. Pain flares with the first step. You’ll start to feel unsure or scared to put full weight on the leg as the hip may collapse and give way.
Standing causes pain and you are always looking for ways to take pressure off the leg, like leaning against a table or wall. Pain intensity rises quickly the longer you stand.
When you reach this stage of AVN of the femoral head, you will have constant, gnawing pain in and around your hip. Resting positions don’t give you much relief anymore and your sleep is poor, if any. It is too painful to sleep on your side and you often wake during the night. Finding a comfortable sleeping position becomes more and more difficult.
Even though you’ll be using stronger pain and anti-inflammatory medication by now, they have little or no effect on your pain. Frustration is at its peak, and irritability is normal given the constant regression you’ve experienced until now. The worst thing you can do is just leave it and hope it start healing by itself, it’s long past normal healing and requires external hip treatment. Wake up and start doing something about it.