Hip Avascular Necrosis

Free vascularized fibular grafting for hip AVN can restore your dying hip.

Hip Avascular Necrosis

Hip avascular necrosis (commonly called “AVN”), also known as femoral head osteonecrosis (“osteo” means bone; “necrosis” means death), results from loss of normal blood flow to the femoral head, or the “ball” that fits into the hip’s socket. The loss of blood flow to the hip ultimately causes the “ball” to die and collapse which leads to extreme pain and loss of hip motion. As collapse of the femoral head further progresses, severe arthritis of the hip joint eventually occurs. Yearly, there are about 20,000 people, most aged in their 20s or 30s, newly diagnosed with hip avascular necrosis.

Dr. Mark A. Katz has additional expertise and subspecialty interest in treating patients with hip avascular necrosis. Dr. Katz obtained extensive fellowship training in the microvascular technique of free vascularized fibular grafting at Duke University Medical Center under the supervision of James R. Urbaniak, M.D., who pioneered this procedure for treatment of hip AVN. As the surgery is highly specialized, there are very few institutions nationwide that offer this procedure routinely. Dr. Katz has experience in over 100 cases of vascularized fibular grafting for hip AVN.

Hip AVN Articles

Nothin HIP about HIP Pain

Read Dr. Katz’ article,
“…Nothing Hip about Hip Pain,” to learn more about hip AVN. Read this article.

How does the 3-step process of Fibular Grafting work?

What are the steps of vascularized fibular grafting to the hip? This simple illustration will help you understand the basics of the procedure. View the illustration.


Read the most frequently asked questions about hip avascular necrosis and vascularized fibular grafting. Read this article.

Hip AVN Stories

High school student Cameron Figueroa from Flagstaff, AZ suffered a devastating injury to his right hip from a skiing accident. He initially underwent surgery for internal fixation of a femoral neck fracture to the hip which was performed by Dr. B. Cashmore of Flagstaff, AZ. Despite successful healing of the fractured bone, Cameron subsequently developed hip avascular necrosis (AVN) of the femoral head or “ball” of the hip, a common complication of femoral neck fractures. Hip AVN results from loss of blood flow to the “ball” of the hip joint which leads to painful collapse of the “ball” and inevitably accelerated hip arthritis. Based on his very young age of 16, total hip replacement is by no means an ideal choice of treatment. Options for treatment to save dying hips are of very limited availability across the country with very few institutions and surgeons offering the microvascular procedure of free vascularized fibular grafting to the hip hip due to its complexity. Cameron and his family found Dr. Mark A. Katz in San Antonio, TX as a last resort for saving his hip. Cameron underwent free vascularized fibular grafting to the hip by Dr. Katz at Foundation Surgical Hospital of San Antonio in 2010. Cameron Figueroa is now over two years from vascularized fibular grafting to the hip and doing well. He was named “Comeback Student Athlete” for 2012 in his hometown of Flagstaff, AZ. Read Cameron’s and his parents’ testimonials below and watch his local news video segment.

“In the fall of 2010 at age 16, I underwent a vascularized fibular graft performed by Dr. Katz. My case of hip AVN had progressed to an unbearable level, and this procedure was my last resort. Dr. Katz spent 3 hours with me initially to see if I was indeed a candidate for this procedure. After he concluded that I would benefit from it, we decided to go for it. With his expertise and guidance, the daunting procedure became tangible….he did it with care and precision. Everything executed by Dr. Katz was outstanding. He assured me of the right steps to take post-op and how exactly I should recover from the procedure. I am now over two years out from the surgery and my pain of AVN has been resolved completely, my scars healed immaculately, and I feel as close to normal as I could possibly feel. With the help of Dr. Katz I have been able to regain much of my former life and have returned to skiing. I have an optimistic outlook for the future of my leg. I couldn’t have asked for a better doctor or facility (Foundation Surgical Hospital of San Antonio) to help me get back to normal.” - C.Figueroa

“As parents, making the complicated decision to have a fibular graft is difficult because it is irreversible. We now know that only someone like Dr. Katz with the expertise, focus and confidence could accomplish this. Everything from start to finish was done with absolute concentration and skill. We cannot thank him enough for restoring the mobility and reduction of pain for our son, who had so few options at his young age.” - H. Figueroa, M.D. and D. Galindo