Ayurvedic Management of Bilateral Avascular Necrosis of the Femoral Head: A Case Study

About Author

Correspondence Address

Dr. Kavita Bhagat
Department of Kayachiktsa,
Shri Ayurved Mahavidyala, Nagpur


Contact No. : 9423018358, Email : bhagatkavitar@gmail.com

Date of Acceptance : 30 Sep 2026

Date of Publication : 30 Sep 2026

Article ID : SD-IJAY_199

How to cite this article : http://doi.org/10.55552/SDNJAY.2026.4305

Abstract

ABSTRACT

Introduction:

Avascular necrosis (AVN), also known as osteonecrosis, is a condition characterized by the death of bone tissue due to inadequate blood supply. It may lead to microfractures, structural collapse, and progressive destruction of the affected bone. Trauma, including fracture or dislocation, prolonged use of high-dose corticosteroids, and excessive alcohol consumption are recognized risk factors. In Ayurveda, the clinical presentation of AVN may be correlated with Asthimajjagata Vata due to the involvement of Asthi and Majja Dhatu with predominance of Vata Dosha. This case report presents the Ayurvedic management of bilateral AVN of the femoral heads.

Methods:

A 42-year-old male diagnosed with bilateral AVN of the femoral heads was evaluated clinically and radiologically. The left femoral head was classified as FICAT stage III and the right femoral head as FICAT stage I. The patient was assessed from both Ayurvedic and contemporary clinical perspectives. Ayurvedic management consisted of Shamana Chikitsa and Shodhana Chikitsa, along with appropriate supportive care. The patient was monitored clinically for changes in pain, walking ability, and functional status during the course of treatment.

Results:

The patient showed gradual clinical improvement following Ayurvedic management, particularly in terms of pain and difficulty in walking. Functional status improved during the treatment period, and the patient was monitored regularly for disease progression and clinical response. The findings suggest a possible role of an individualized Ayurvedic therapeutic approach in the symptomatic and functional management of bilateral AVN.

Discussion:

The present case demonstrates the clinical complexity of bilateral AVN of the femoral heads, particularly when the two hips are at different stages of disease progression. Correlation with Asthimajjagata Vata provides an Ayurvedic framework for understanding the involvement of Asthi and Majja Dhatu and the role of Vata Dosha. The case emphasizes the importance of early diagnosis, timely intervention, regular monitoring, and multidisciplinary care in managing AVN. However, as this is a single case report, larger clinical studies with objective radiological and functional outcomes are required to establish the efficacy and safety of Ayurvedic interventions in AVN.

Introduction

INTRODUCTION:

Avascular necrosis (AVN), also known as osteonecrosis, is a condition characterized by the death of bone tissue due to inadequate blood supply. Progressive vascular insufficiency may result in microfractures, structural collapse of the affected bone, and subsequent joint dysfunction. The disease may develop gradually over several months to years. Trauma, including fracture or dislocation, can disrupt the blood supply to the affected bone. Non-traumatic factors such as prolonged use of high-dose corticosteroids and excessive alcohol consumption are also recognized risk factors.

AVN can occur at any age but is more commonly observed in adults between 30 and 50 years of age. In the early stages, patients may remain asymptomatic. With disease progression, pain may initially occur during weight-bearing activities and may later become persistent, including at rest. Involvement of the hip commonly produces pain in the groin, thigh, or buttock. Although the femoral head is one of the most frequently affected sites, AVN may also involve the shoulder, knee, hand, and foot. Bilateral involvement, particularly of the femoral heads, may also occur ^[1].

The pathogenesis of AVN involves interruption or reduction of the blood supply to the bone. The etiological factors may broadly be classified as traumatic and non-traumatic. Traumatic causes include fractures and joint dislocations, which may damage or compress the blood vessels supplying the affected bone. Radiation therapy may also cause vascular and osseous injury, increasing the risk of osteonecrosis. Vascular obstruction due to fatty deposits may further compromise the microcirculation of bone ^[2,3]. Medical conditions such as sickle cell disease and Gaucher disease may also impair bone perfusion. In some cases, particularly non-traumatic AVN, the underlying cause remains unidentified. Genetic predisposition, excessive alcohol consumption, prolonged corticosteroid therapy, certain medications, and systemic disorders may contribute to its development.

If left untreated, AVN may progress to collapse of the affected bone. Involvement of the femoral head can result in loss of its normal spherical contour and may subsequently lead to secondary osteoarthritis of the hip joint. Early diagnosis and appropriate intervention are therefore important to limit disease progression, preserve joint function, and reduce disability ^[4].

From an Ayurvedic perspective, the clinical features of AVN may be interpreted in relation to Asthimajjagata Vata, considering the involvement of Asthi and Majja Dhatu and the predominance of Vata Dosha. However, the correlation between AVN and Asthimajjagata Vata is a clinical interpretation rather than a direct one-to-one equivalence between the two diagnostic systems.

The present case report describes the clinical presentation and Ayurvedic management of a patient with bilateral AVN of the femoral heads and explores its clinical correlation with Asthimajjagata Vata.

Discussion

DISCUSSION

AVN of the femoral head is a progressive condition in which compromised blood supply may eventually result in structural collapse and secondary joint degeneration. Bilateral involvement and differences in disease stage between the two femoral heads can make clinical management particularly challenging. In Ayurveda, the clinical presentation may be considered in the context of Asthimajjagata Vata, with involvement of Asthi and Majja Dhatu and the role of aggravated Vata Dosha. The treatment approach in the present case was therefore planned using both Shamana and Shodhana principles, with the objective of addressing the clinical manifestations and functional impairment.

The gradual improvement in pain and walking ability observed in this case is clinically relevant; however, these observations should be interpreted cautiously because this is a single case report. Objective radiological assessment and longer follow-up would be necessary to determine whether Ayurvedic treatment has any effect on the structural progression of AVN.

The primary objective of the treatment was conservative management aimed at reducing pain, improving mobility, preserving functional capacity, and enhancing the patient's quality of life. The patient's chief complaint was bilateral hip joint pain, which, from an Ayurvedic perspective, may be considered indicative of Vata Dosha involvement with predominant affection of Asthi Dhatu and Asthivaha Srotas^.[5]

Avascular necrosis (AVN) occurs due to impaired or interrupted blood supply to the affected bone, resulting in progressive bone tissue damage. From an Ayurvedic perspective, the clinical presentation of AVN may be correlated with Asthimajjagata Vata, in which aggravated Vata affects Asthi and Majja Dhatu. The concept of Marga Avarodha may be used to interpret obstruction or impairment of the normal pathways associated with the circulation and nourishment of the affected tissues. However, this Ayurvedic interpretation should be considered a clinical correlation rather than a direct equivalence between AVN and Asthimajjagata Vata.^[6]

Prolonged aggravation of Vata may contribute to Asthi Dhatu Kshaya and manifestations such as pain, stiffness, and restricted movement. Therefore, the treatment protocol was planned with consideration of Vata Dosha, Asthi Dhatu, and the nourishment of the affected tissues. Measures aimed at improving local circulation and supporting tissue nourishment were incorporated into the treatment plan.^[7]

Jalaukavacharana (leech therapy) was included as part of the treatment protocol based on its traditional Ayurvedic indication in conditions involving localized vascular congestion and for its Rakta Prasadana effect. Its use in this case was intended as an adjunctive measure rather than as a direct treatment for the underlying vascular pathology of AVN. The specific clinical effects observed in the present patient should be interpreted in relation to the documented outcomes^.[8]

According to Acharya Charaka, the management of Asthi Dhatu Kshaya includes Panchakarma, with particular importance given to Basti therapy. Medicated Basti preparations containing Ksheera, Ghrita, and Tikta Dravyas are described in the Ayurvedic literature in the context of disorders involving Asthi Dhatu. Based on this principle, Panchatikta Ksheera Basti was incorporated into the treatment protocol. ^[9,10]

The ingredients and therapeutic principles of Panchatikta Ksheera Basti may provide Tikta and other relevant Rasa properties, while Ksheera is described as Jeevaniya and Brimhana. Ghrita is traditionally considered supportive of tissue nourishment and is used in Vata-predominant conditions. Guggulu Tiktaka Ghrita, where used, may be considered in the context of Vata management and Dhatu Poshan. These Ayurvedic concepts provide the rationale for incorporating such formulations into the treatment protocol. ^[11,12]

Basti is traditionally regarded as an important therapeutic modality for the management of Vata Dosha. Therefore, in the present case, Basti was selected with the objective of addressing Vata predominance and supporting the nourishment and functional integrity of Asthi Dhatu. The proposed Ayurvedic mechanism should not be interpreted as proving that Basti directly restores the blood supply to the femoral head; rather, it represents the Ayurvedic rationale underlying its use in the present case ^[13,14].

In addition to Basti, the treatment protocol included Snehana, Shashtika Shali Pinda Sweda, Jalaukavacharana, and appropriate internal medications. These therapies were planned with the objectives of alleviating pain and stiffness, improving local mobility, providing Snehana and Swedana, supporting Vata management, and improving functional status.

Conclusion

CONCLUSION:

This case highlights the clinical challenges associated with bilateral AVN of the femoral heads and presents its possible Ayurvedic correlation with Asthimajjagata Vata. The patient showed gradual improvement in pain and functional ability following individualized Ayurvedic management. Early diagnosis, timely intervention, regular clinical and radiological monitoring, and appropriate multidisciplinary care remain important in the management of AVN. Further prospective studies with larger sample sizes, standardized treatment protocols, objective functional measures, and radiological outcomes are required to evaluate the role of Ayurvedic interventions in AVN.

In the present case, a combination of Tikta Ksheera Basti, Jalaukavacharana, Shashtika Shali Pinda Sweda, Shamana Chikitsa, and other supportive Ayurvedic therapies was associated with gradual improvement in clinical symptoms, particularly pain, difficulty in walking, and functional mobility.

The observed improvement suggests that the treatment protocol may provide symptomatic and functional benefits in a patient with AVN. However, as this report is based on a single case, the findings cannot be generalized to the wider population, and it is not possible to establish the efficacy of the treatment or determine whether it alters the natural course of AVN.

Further studies involving larger sample sizes, appropriate study designs, standardized outcome measures, longer follow-up periods, and radiological assessment are required to evaluate the effectiveness and safety of Ayurvedic interventions in AVN. Serial MRI or other appropriate imaging modalities may be considered during follow-up to assess structural changes in the femoral head. Any radiological improvement or reversal should be demonstrated objectively through comparative imaging rather than assumed from symptomatic improvement alone.

References

REFERENCES:

1. Jones LC, Mont MA, Collins KA. Clinical manifestations and diagnosis of osteonecrosis (avascular necrosis of bone). UpToDate. Seo P (ed): Wolters Kluwer, Philadelphia, PA. 2022 Jul.
2. Mayo Clinic. Avascular necrosis (osteonecrosis) – Symptoms and causes. Accessed February 5, 2022.
3. Bridges SL. National institute of arthritis and musculoskeletal and skin diseases. Arthritis Research & Therapy. 2000 Jan 25;2(1):0003.
4. Hines JT, Jo WL, Cui Q, Koo KH, Cheng EY, et al. Osteonecrosis of the femoral head: an updated review of ARCO on pathogenesis, staging and treatment. J Korean Med Sci. 2021;36(10). doi:10.3346/jkms.2021.36.e177.
5. Lawrence DT, et al. Ayurvedic management of avascular necrosis of femoral head: a case report. Int Ayurvedic Med J. 2022.
6. Acharya YT, editor. Charaka Samhita of Agnivesha, with the Ayurveda Dipika commentary of Chakrapanidatta. Sutrasthana, Chapter 28, Vividhashitapitiya Adhyaya. Varanasi: Chaukhambha Surbharati Prakashan; 2014. p.179.
7. Acharya YT, editor. Charaka Samhita of Agnivesha, with the Ayurveda Dipika commentary of Chakrapanidatta. Sutrasthana, Chapter 28, Vividhashitapitiya Adhyaya. Varanasi: Chaukhambha Surbharati Prakashan; 2014. p.179.
8. Raut SK, Dachewar AS. Ayurvedic approach in the management of lumbar intervertebral disc annular tear: a case study.
9. Tembhekar R, Chandaliya SS. Mode of action of Shalishashtika Pinda Sweda: a review. World J Pharm Res. 2021;10(13):356-357.
10. Acharya YT, editor. Charaka Samhita of Agnivesha, with the Ayurveda Dipika commentary of Chakrapanidatta. Sutrasthana, Chapter 28, Vividhashitapitiya Adhyaya. Varanasi: Chaukhambha Surbharati Prakashan; 2014. p.179.
11. Weinfeld AB, Yuksel E, Boutros S, Gura DH, Akyurek M, Friedman JD. Clinical and scientific considerations in leech therapy for the management of acute venous congestion: an updated review. Ann Plast Surg. 2000;45:207-212.
12. Kaviraj Govind Das Sen. Bhaishajya Ratnavali. Vataroga Adhikara.
13. Kaviraj Govind Das Sen. Bhaishajya Ratnavali. Visphot Chikitsa Prakarana
14. Vagbhata. Ashtanga Hridaya, Chikitsasthana, Chapter 21, verses 57-60.
15. Charaka Samhita, Chikitsa Sthana, Vatarakta Chikitsa, 29/119. Description of Bala Taila and its use in Vata disorders.
16. Bhaidkar KN, et al. Holistic Management of AVN Through Panchakarma: A Case Report. J Clin Diagn Res. 2026;20(5):JD01-JD05. doi:10.7860/JCDR/2026/80442.23322.
17. Mangal G, Srivastava P. Functional Outcome of Basti Karma in Avascular Necrosis of Femoral Head – A Case Report. Journal of Ayurveda. 2018;12(4).
18. Lahari C, Lakshmana Prasad V. Clinical Approach to Gambhira Vatarakta (Avascular Necrosis of Femoral Head) Through Ayurveda: A Case Study. World Journal of Pharmaceutical Research.
19. Negi S, Padavi DM. Ayurveda’s Approach to Avascular Necrosis: A Case Study. International Research Journal of Ayurveda & Yoga. 2023. doi: 10.48165/IRJAY.2023.6904.
20. Kumar S, Mangal G. Pharmacodynamics of Panchatikta Guggulu Ghrita in Asthimajjagata Vata with special reference to avascular necrosis of femoral head. World Journal of Pharmaceutical Sciences. 2022;10(8):16–19. doi: 10.54037/WJPS.2022.100801.
21. Majhi RK, et al. Ayurvedic management of Asthimajja Gata Vata w.s.r. to AVN of head of femur – A case study. International Ayurvedic Medical Journal. 2023;14(3):866–872.
22. Vishnu Damodar, et al. Ayurvedic Management of Bone Fracture in Smaller Bones: A Single Case Study. International Ayurvedic Medical Journal.
23. Agnivesha. Charaka Samhita. Revised by Charaka and Dridhabala; with Ayurveda Dipika commentary of Chakrapani Datta. Chikitsa Sthana, Jwara Chikitsa. Varanasi: Chaukhambha Surbharati Prakashan
24. Vagbhata. Ashtanga Hridaya. With Sarvangasundara commentary of Arunadatta and Ayurveda Rasayana commentary of Hemadri. Chikitsa Sthana, Jwara Chikitsa. Varanasi: Chaukhambha Surbharati Prakashan