Hip Pain After Steroid Treatment: Could It Be Avascular Necrosis?

A few months ago you were very unwell. Perhaps it was COVID with low oxygen, a bad asthma attack, a kidney problem, a severe skin or allergic reaction, or a flare of an autoimmune illness. The doctors gave you steroids, maybe as a drip in hospital and then tablets at home, and they helped you pull through. You are back at work now, riding your two-wheeler again, and life is almost normal. Except for one thing: a dull ache deep in the groin that was not there before. It is worse after walking around the market, it makes the stairs harder, and lately it nags at night.

Most people put this down to weakness after the illness, a pulled muscle or simply age. Sometimes that is right. But groin pain that starts in the months after a strong steroid course can be the first sign of avascular necrosis (AVN), where part of the ball of the hip loses its blood supply. In this guide, our pain specialists explain why steroids and hip pain are linked, why an MRI matters more than an X-ray at this point, the early signs to watch for, how to protect your hip without touching the medicines you have been prescribed, and an honest look at treatment at each stage.

Why can steroid treatment lead to hip pain months later?

Steroids (doctors call them corticosteroids or glucocorticoids) are powerful medicines that calm inflammation and the immune system. In serious illness they save lives, and nothing in this article should make you regret a treatment that was needed at the time.

The trouble is that steroids also affect bone and blood vessels. The exact mechanism is still being studied, but the leading explanations are that steroids enlarge fat cells inside the bone marrow, raise fats in the blood, make the blood more prone to tiny clots and slow the bone’s own repair. The ball of the thigh bone, the femoral head, is fed by a small number of narrow vessels with very little back-up. When pressure inside the bone rises and flow slows, a wedge of bone under the joint surface can quietly die. If you want the full background on the condition itself, read our main guide to avascular necrosis of the hip.

Here is the part that catches people out. Dead bone does not hurt straight away. It hurts when it begins to weaken and the body tries to repair it, which typically takes months. So the hip pain arrives long after the hospital stay, when everyone has moved on.

What about steroids given during COVID?

Steroids became a standard part of treatment for people with moderate to severe COVID who needed oxygen. Many patients received high doses, some for several weeks, and some also took extra courses from different doctors or bought steroid tablets without a prescription during the panic of the second wave. Orthopaedic doctors in India began reporting hip AVN in people who had recovered from COVID, sometimes appearing sooner after the steroid course than they usually see. Researchers are still working out whether the virus itself adds to the risk by affecting small blood vessels.

The practical message is simple: if you had COVID treated with steroids and now have groin or hip pain that does not settle, tell your doctor about it plainly and ask whether an MRI is needed.

Other illnesses where steroids are commonly used

• Severe asthma or COPD attacks needing repeated tablet or drip courses
• Lupus, vasculitis, rheumatoid arthritis and other autoimmune conditions, including muscle conditions such as myasthenia gravis and myositis
• Kidney conditions such as nephrotic syndrome, and organ transplants
• Some blood cancers and chemotherapy plans
• Severe skin, eye or allergic conditions, and swelling around the brain or spinal cord
• Repeated steroid injections into joints or the spine, such as epidural steroid injections, and unlabelled “pain relief” powders or “weight gain” tablets that secretly contain steroids

The risk is linked mainly to higher daily doses and longer or repeated courses. Not everyone who takes steroids develops AVN; in fact, most do not. Other factors add to the risk, including heavy alcohol use, high cholesterol or triglycerides, smoking and blood clotting tendencies. People who already live with diabetes often see their sugar shoot up on steroids, and many long-term effects are covered in our guide to steroid side effects.

Early signs of hip AVN after steroids

Watch for this pattern in the months after a steroid course:

• A deep, dull ache in the groin, sometimes felt in the buttock, the front of the thigh or even the knee.
• Pain that starts with walking or standing and eases with rest, at first.
• Pain at night or at rest as weeks pass.
• Stiffness and pain when turning the leg inwards, so putting on socks, sitting cross-legged, squatting or getting out of an auto becomes awkward.
• A limp that family members notice before you do.
• Pain in both hips, or later in the knees or shoulders. Steroid-related AVN often affects more than one joint, so ache in other big joints is worth mentioning too. If several joints are stiff, our guide on morning joint stiffness helps sort out other causes.

After a long illness, many people also feel general muscle aches, tiredness and poor sleep, which can look a little like fibromyalgia. The difference is that AVN pain is focused in one place, the groin, and gets steadily worse with weight-bearing.

Why groin pain after steroids needs an MRI, not just an X-ray

In early AVN, the ball of the hip still looks round and normal on an X-ray. The changes, such as patchy whitening, a thin crescent line under the surface or flattening, only show once the disease is well established. By then, the window for protecting the joint may be closing.

MRI shows the water and fat inside bone, so it can pick up the dead area weeks to months before X-ray changes appear. It also tells us how large the area is, where it sits in the weight-bearing part of the ball, whether there is swelling in the marrow, and whether the other hip is affected even if it does not hurt yet. That is why, after steroids, we usually ask for an MRI of both hips. If the report reads like a foreign language, our guide to reading an MRI report explains the general vocabulary, and we always go through yours with you.

Blood tests help too: sugar, cholesterol and triglycerides, liver tests, vitamin D levels, and sometimes clotting tests. Steroids also thin bone in general, so checking for osteoporosis is often sensible.

Other causes of hip pain after illness

Not every hip pain after steroids is AVN. Pain on the outside of the hip that hurts when you lie on that side is more typical of trochanteric bursitis. Buttock pain travelling down the leg with tingling suggests sciatica or piriformis syndrome, and ache over the back of the pelvis may come from the SI joint. In older adults, groin pain is often hip osteoarthritis, and women have a few extra causes covered in hip pain in women. After long steroid use, a small stress fracture from thin bone is also possible. Careful examination plus the right scan sorts these out.

How to protect your hip after a steroid course

First, a word about your medicines

Please do not stop or cut down any prescribed steroid on your own, whether tablets, inhalers or injections. After a few weeks of steroid tablets, your body’s own steroid production switches down, and stopping suddenly can make you seriously ill. Your underlying condition may also flare. If you are worried, speak to the doctor who prescribed the steroid. They may be able to adjust the dose, taper it slowly, or consider other medicines, but that decision belongs with them and with you, together. Asthma inhalers deliver a much smaller dose to the body than tablets, and keeping asthma well controlled actually reduces the chance of needing strong steroid courses later.

What you can do is make sure every doctor you see knows about all the steroids you have taken: hospital drips, tablets, joint injections, and any unlabelled medicines from a local shop. Bring those strips and bottles with you.

Everyday steps that protect the hip

• Do not walk through worsening groin pain. If AVN is suspected, your doctor may advise a walking stick or crutches for a period. Hold a stick in the hand opposite the painful hip.
• Choose low-impact movement. Swimming, a stationary cycle and upper-body exercise keep you fit. Avoid running, jumping, deep squats and lifting heavy things such as a gas cylinder or water cans.
• Keep weight in check. Each extra kilo loads the hip with every step, as explained in weight and joint pain.
• Cut out alcohol and smoking, both of which add to the risk to bone blood supply.
• Eat for bones and vessels. Protein, pulses, vegetables, calcium-rich foods and less fried food and sugar. Our guide on diet and arthritis pain has practical ideas.
• Do not hide the pain with tablets. Painkillers can let you keep overloading a weak bone. Read why painkillers are not the answer.
• Look after sleep. Night pain and poor sleep make each other worse, as explained in sleep and chronic pain. A pillow between the knees often helps.

Honest treatment options by stage

What helps depends mostly on one question: has the ball of the hip collapsed yet? The size and position of the dead area, whether both hips are affected, your age and your general health also matter. This simplified table shows how options change.

A word on procedures you may hear about. Core decompression is a surgical procedure in which small channels are drilled into the dead area to relieve pressure in the bone and encourage new blood vessels. It works best when the area is small and the ball has not collapsed, and it is sometimes combined with bone grafts or cell-based treatments. Some medicines, such as bisphosphonates, have been studied to slow collapse, with mixed results so far. After collapse with arthritis, no injection, diet or exercise can make the ball round again, and we will say that clearly. If you have been advised surgery and want to be sure, our guide to a second opinion before surgery or injections lists questions that apply equally to the hip.

How Dr Heal treats hip pain after steroid treatment

Our hip pain treatment for people who have had steroids is built around catching AVN early and being truthful about what each stage allows. A typical plan:

1. A complete steroid and health history. Every course, dose and duration we can trace, plus alcohol, smoking, sugar and past injuries. We examine both hips and the other large joints, then arrange MRI and blood tests, using the in-house laboratory and radiology at our facilities.
2. Working with your other doctors. We never ask you to stop a prescribed medicine. If your steroid plan needs review, we share our findings with the doctor treating your asthma, kidney or autoimmune condition so that any change is made safely by them.
3. Healing support without more steroids. For suitable early-stage hips, we may offer an injection from Dr Heal Pharma’s own regenerative preparation. It is free of steroids, painkillers and antibiotics, which matters when steroids are part of the reason the hip is struggling. Read how regenerative medicine aims to support the body’s repair.
4. Bone, sugar and lifestyle care. Through functional medicine and clinical nutrition, we work on blood sugar, lipids, vitamin D, weight, sleep and stress, all of which affect bone health after a hard illness.
5. Guided rehabilitation, follow-up and honest referral. Protected walking, then strengthening of the buttock and thigh muscles, with regular review. If the ball begins to collapse or a joint-preserving procedure is likely to help, we refer you to the right surgeon without delay.

If knees or shoulders ache as well, our joint pain and arthritis treatment looks at the whole picture, and you can meet our pain specialists before you decide.

Frequently asked questions

How long after steroids can avascular necrosis start?

Symptoms most often appear within months to about two years of a high-dose or long steroid course, though it can be earlier or later. Any new groin pain in that period deserves a proper check.

I had steroids for COVID. Should I get an MRI even without pain?

Routine MRI without symptoms is not usually needed. If you develop groin, hip, knee or shoulder pain that does not settle within a couple of weeks, see a doctor and mention the steroids, so they can decide whether an MRI is needed.

Should I stop my steroid tablets if my hip hurts?

No. Stopping steroids suddenly can be dangerous and can make your original illness flare. Speak to the doctor who prescribed them; any change should be gradual and supervised.

My X-ray was normal. Am I safe?

Not necessarily. Early AVN often does not show on X-ray. If pain persists and you have had steroids, MRI is the test that can find it early, while the joint can still be protected.

Can AVN after steroids affect other joints?

Yes. Steroid-related AVN is often seen in both hips and can also affect the knees, shoulders or ankles. Pain in several large joints after a steroid course should be mentioned to your doctor. Our knee pain treatment and shoulder pain treatment pages explain how we assess those joints.

Where can I get hip pain after steroid treatment checked in Bengaluru?

Dr Heal Pain Cure Hospital assesses hip pain and AVN at its HSR Layout and Banashankari branches, both open 24 hours with in-house radiology and laboratory tests. Patients come to us from all over Karnataka.

This article is for general information and is not a substitute for a medical consultation. Please see a doctor for advice about your own symptoms, and do not change prescribed medicines without speaking to your doctor.