Idiopathic Avascular Necrosis of the Femoral Head in an Older Adult: A Case Report.

Avascular necrosis (AVN) of the femoral head is a rare but serious cause of hip pain, often presenting with non-specific symptoms that can be mistaken for more common musculoskeletal conditions. We report the case of a 65-year-old Asian male, a retired taxi driver without traditional AVN risk factors, who presented with a three-month history of progressive right hip pain - characterized as a dull, constant ache that sharpened during weight-bearing activities - and associated limping. Clinical examination revealed antalgic gait, restricted hip range of motion, and positive orthopedic tests, prompting imaging that confirmed AVN with subchondral collapse. Conservative management involving manual therapy, joint mobilization, and exercise offered only temporary symptomatic relief, and the patient eventually required total hip replacement. This case underscores the importance of careful assessment, early imaging, and multidisciplinary collaboration in managing persistent hip pain, while also highlighting the need for musculoskeletal clinicians to be vigilant for vascular pathologies and rare conditions such as AVN, particularly in older adults and those with chronic inflammatory disorders.