Diagnosis of Osteonecrosis X-rays MRI Osteonecrosis should be suspected in patients with the following: Previous fractures (eg, displaced subcapital femoral head fractures), joint dislocations (eg, hip dislocations), or other risk factors (eg, corticosteroid use, hemoglobinopathies), particularly if pain persists or worsens Persistent spontaneous hip, knee, or shoulder pain, particularly if risk factors for osteonecrosis are present Plain x-rays should be done initially.