Avascular necrosis (AVN) of the hip is a devastating cause of progressive femoral head osteonecrosis in young adults. Learn the critical staging, pathophysiologyand surgical management strategies to determine when to preserve the joint versus when to replace it. ⏱ Chapters 0:00 Intro 0:29 Essentials 1:01 Aseptic 1:38 Medal 2:12 Ficat 2:42 Steinberg 3:09 Algorithm 3:43 Drill 4:11 Revision 4:42 Numbers 5:15 Clinical reasoning — Manage 5:46 Clinical reasoning — Pearls This OrthoVellum masterclass provides a comprehensive deep dive into the evaluation and management of avascular necrosis of the femoral head. Covering everything from the tenuous vascular anatomy and ASEPTIC risk factors to Ficat-Arlet and Steinberg staging systems, this video outlines the exact clinical thresholds for joint preservation versus total hip arthroplasty. 🦴 IN THIS VIDEO YOU'LL LEARN • How to identify the critical radiographic crescent sign indicating imminent femoral head collapse • Using the ASEPTIC mnemonic to categorise the diverse causes of osteonecrosis • The vascular anatomy of the femoral head and why retinacular vessel disruption is catastrophic • Applying the Ficat-Arlet and Steinberg classification systems to guide orthopaedic treatment • Indications and biomechanical principles of core decompression for pre-collapse AVN • Determining when to perform a valgus osteotomy versus a total hip arthroplasty • Why lesion size drastically affects the prognosis of joint-preserving surgery • The unique orthopaedic considerations and peri-operative protocols for sickle cell disease patients ⏱️ CHAPTERS 📌 KEY TAKEAWAYS ✔️ Always image the contralateral hip as 50-80% of AVN cases are bilateral within two years. ✔️ The crescent sign on X-ray signals a subchondral fracture, marking the failure point for joint preservation. ✔️ Core decompression works by reducing intraosseous pressure from over 30mmHg to under 10mmHg, but only works before head collapse. ✔️ Medial circumflex femoral artery provides 70-80% of blood supply; its disruption in femoral neck fractures causes a 30% AVN rate. ✔️ Total hip arthroplasty in AVN patients has higher failure and revision rates than in primary osteoarthritis. 👩⚕️ WHO THIS IS FOR This masterclass is essential for orthopaedic trainees, junior doctorsand medical students seeking a comprehensive understanding of adult reconstruction. Curious patients suffering from hip pain or osteonecrosis will also find valuable insights into their condition and surgical options. 📚 RELATED TOPICS: Femoral Neck Fractures and Fixation · Total Hip Arthroplasty in Young Adults · Core Decompression Surgical Technique · Vascularised Fibular Grafting for AVN · Steinberg and ARCO Classification of Osteonecrosis 🔗 More free orthopaedic teaching at Orthovellum.com — subscribe for weekly videos. 🎨 CREDITS • Original Orthovellum production. ⚠️ DISCLAIMER: Educational only — not individual medical advice. Always consult a qualified clinician for diagnosis and treatment. #orthopaedics #avascularnecrosis #osteonecrosis #hippain #femoralhead #jointpreservation #adultreconstruction #orthovellum #coredecompression #totalhiparthroplasty #orthopedicsurgery #crescentsign #femoralneckfracture #medicalstudent #orthopedics