1887
Volume 2025, Issue 2
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

The SARS-CoV-2 pandemic (COVID-19) has significantly impacted global health, with emerging evidence indicating potential long-term complications affecting various organ systems, including the musculoskeletal system, like avascular necrosis (AVN) of the femoral head. This retrospective study aims to investigate the incidence and risk factors of AVN in patients treated for COVID-19.

We conducted a cross-sectional retrospective study in the department of orthopedics at a tertiary care teaching hospital in Central India from July 2022 to December 2023. Patients presenting with new-onset hip pain and low back pain who were asymptomatic before COVID-19 with a new radiological diagnosis of AVN hip were included in the study. Data on demographics, comorbidities, steroid use, and COVID-19 management were collected and analyzed using statistical tests to identify associations between these factors and AVN incidence.

A total of 86 patients met the inclusion criteria. The majority of participants were males (83.7%), predominantly within the 30–45 years (44.2%) and 15–30 years (30.2%) age groups. Bilateral AVN was observed in 62.8% of cases. A significant portion (25.6%) had a history of COVID-19, with steroid use prevalent among 30.2% of participants, with an odds ratio of 4.47 indicating strong association. Statistically significant associations were found between COVID-19 status and age distribution ( = 0.049), comorbidities ( = 0.014), symptom onset (p = 0.001), and steroid therapy history ( = 0.002).

This study highlights a notable incidence of AVN among COVID-19 patients, with significant correlations to steroid use and specific comorbidities. The findings underscore the importance of vigilant monitoring for AVN in post-COVID-19 patients, particularly those with a history of steroid therapy. Further research is needed to elucidate the mechanisms linking COVID-19 and AVN and to develop targeted prevention strategies.

© 2025 Sharma, Bhansal, Khan, Uikey, Tavethia, Bhadania, et al., licensee HBKU Press.
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2025-06-30
2025-07-17
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References

  1. Matthews AH, Davis DD, Fish MJ, Stitson D. Avascular necrosis. StatPearls Publishing;2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537007/
     [Google Scholar]
  2. Shah KN, Racine J, Jones LC, Aaron RK. Pathophysiology and risk factors for osteonecrosis. Curr Rev Musculoskelet Med. 2015; 8:(3):201–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4596210/
     [Google Scholar]
  3. Femoral head avascular necrosis: practice essentials, etiology, epidemiology. eMedicine. 2023. Available from: https://emedicine.medscape.com/article/86568-overview?form=fpf
     [Google Scholar]
  4. Sulewski A, Sieroñ D, Szyluk K, Dàbrowski M, Kubaszewski Ł, Lukoszek D, et al.. Avascular necrosis bone complication after active COVID-19 infection: preliminary results. Medicina. 2021; 57:(12):1311. Available from: https://www.mdpi.com/1648-9144/57/12/1311
     [Google Scholar]
  5. Disser NP, De Micheli AJ, Schonk MM, Konnaris MA, Piacentini AN, Edon DL, et al.. Musculoskeletal consequences of COVID-19. J Bone Joint Surg. 2020; 102:(14):1197–204.
    [Google Scholar]
  6. Sapriati AN, Rahmawati F, Nuryastuti T. Treatment of the cytokine storm in COVID-19: review of clinical pharmacology. J Sains Far Klin. 2023; 10:(2):162. https://doi.org/10.25077/jsfk.10.2.162-183.2023
     [Google Scholar]
  7. McElvaney OJ, McEvoy NL, McElvaney OF, Carroll TP, Murphy MP, Dunlea DM, et al.. Characterization of the inflammatory response to severe COVID-19 illness. Am J Respir Crit Care Med. 2020; 202:(6):812–21.
    [Google Scholar]
  8. Liu F, Li L, Xu M, Wu J, Luo D, Zhu Y, et al.. Prognostic value of interleukin-6, C-reactive protein, and procalcitonin in patients with COVID-19. J Clin Virol. 2020; 127:: 104370.
    [Google Scholar]
  9. Ackermann M, Verleden SE, Kuehnel M, Haverich A, Welte T, Laenger F, et al.. Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in Covid-19. N Engl J Med. 2020; 383:(2):120–8.
    [Google Scholar]
  10. Gómez-Mesa JE, Galindo-Coral S, Montes MC, Muñoz Martin AJ. Thrombosis and coagulopathy in COVID-19. Curr Probl Cardiol. 2021; 46:(3):100742. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7605852/
     [Google Scholar]
  11. Annam P, Manda A, Myneni UK, Sahar AN, Prasad N, Sam KK, et al.. Corticosteroids induced avascular necrosis of hip, a “long COVID-19” complication: case report. Ann Med Surg (Lond). 2022; 82:: 104753. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9500083/
     [Google Scholar]
  12. Handayani M, Rizaldy MB. Avascular necrosis. J Kedokteran Diponegoro (Diponegoro Med J). 2023; 12:(5):326–9. https://doi.org/10.14710/dmj.v12i5.38551
     [Google Scholar]
  13. Velkovski V, Shabani I, Kamnar V, Gavrilovski A, Todorova T, Bogojevska-Doksevska M, et al.. Avascular necrosis of the femoral head in patient with Lyme disease and Devic’s optic neuritis. Arch Public Health. 2023; 15:(1):126–33. https://doi.org/10.3889/aph.2023.6078
     [Google Scholar]
  14. Xue X, Feng Z, Li Z, Pan X. Salidroside inhibits steroid-induced avascular necrosis of the femoral head via the PI3K/Akt signaling pathway: in vitro and in vivo studies. Mol Med Rep. 2017; 17:(3):3751–7. https://doi.org/10.3892/mmr.2017.8349
     [Google Scholar]
  15. Zhang C, Zou YL, Ma J, Dang XQ, Wang KZ. Apoptosis associated with Wnt/β-catenin pathway leads to steroid-induced avascular necrosis of femoral head. BMC Musculoskelet Disord. 2015; 16:(1):132.
    [Google Scholar]
  16. Huang W, Jin S, Yang W, Tian S, Meng C, Deng H, et al.. Protective effect of Agrimonia pilosa polysaccharides on dexamethasone-treated MC3T3-E1 cells via Wnt/β-Catenin pathway. J Cell Mol Med. 2020; 24:(3):2169–77. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7011133/
     [Google Scholar]
  17. Bai SC, Xu Q, Li H, Qin YF, Song LC, Wang CG, et al.. NADPH oxidase isoforms are involved in glucocorticoid-induced preosteoblast apoptosis. Oxid Med Cell Longev. 2019; 2019:: 2019:9192413. Available from: https://pubmed.ncbi.nlm.nih.gov/31049140/
     [Google Scholar]
  18. Liu S, Huang Y, Wang C, Tian S, Xu Y, Ge J. Epimedium protects steroid induced avascular necrosis of femoral head in rats by inhibiting autophagy. Exp Ther Med. 2018; 16:(6):5047–52.
    [Google Scholar]
  19. Mok MY. Risk factors for avascular necrosis of bone in patients with systemic lupus erythematosus: is there a role for antiphospholipid antibodies? Ann Rheum Dis. 2000; 59:(6):462–7.
    [Google Scholar]
  20. Vardhan H, Tripathy SK, Sen RK, Aggarwal S, Goyal T. Epidemiological profile of femoral head osteonecrosis in the North Indian population. Indian J Orthop. 2018; 52:(2):140–6. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5858207/
     [Google Scholar]
  21. Barile MF, Wu JS, McMahon CJ. Femoral head avascular necrosis: a frequently missed incidental finding on multidetector CT. Clin Radiol. 2014; 69:(3):280–5.
    [Google Scholar]
  22. Malizos KN, Karantanas AH, Varitimidis SE, Dailiana ZH, Bargiotas K, Maris T. Osteonecrosis of the femoral head: etiology, imaging and treatment. Eur J Radiol. 2007; 63:(1):16–28.
    [Google Scholar]
  23. Arbab D, König DP. Atraumatic femoral head necrosis in adults. Dtsch Aerztebl Int. 2016; 113:(3):31–8.
    [Google Scholar]
  24. Modrzewski K, Gagała J. Deceptive low back pain and pseudoradicular signs in avascular necrosis of the femoral head. Ortop Traumatol Rehabil. 2024; 6:(5):613–7. Available from: https://pubmed.ncbi.nlm.nih.gov/17618211/
     [Google Scholar]
  25. Silaghi-Dumitrescu R, Patrascu I, Lehene M, Bercea I. Comorbidities of COVID-19 patients. Medicina (Kaunas). 2023; 59:(8):1393. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10456773/#:~:text=More%20severe%20symptoms%20appear%20especially
     [Google Scholar]
  26. Sanchez-Ramirez DC, Mackey D. Underlying respiratory diseases, specifically COPD, and smoking are associated with severe COVID-19 outcomes: a systematic review and meta-analysis. Respir Med. 2020; 171:: 106096.
    [Google Scholar]
  27. Metz VE, Palzes VA, Chi FW, Campbell CI, Sterling SA. Alcohol use among young adults in Northern California during the COVID-19 pandemic—an electronic health records-based study. Front Psychiatry. 2022; 13:: 883306. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9315391/
     [Google Scholar]
  28. Chang C, Greenspan A, Gershwin ME. The pathogenesis, diagnosis and clinical manifestations of steroid-induced osteonecrosis. J Autoimmun. 2020; 110:: 102460.
    [Google Scholar]
  29. Sakellariou E, Argyropoulou E, Karampinas P, Galanis A, Varsamos I, Giannatos V, et al.. A comprehensive review of COVID-19-infection- and steroid-treatment-associated bone avascular necrosis: a multi-study analysis. Diagnostics (Basel). 2024; 14:(3):247.
    [Google Scholar]
  30. Jyothiprasanth M, Jithin CR, Vincent A, Thomas AK, Pratheesh CB, Sarang P. A case series on Covid-19 infection and avascular necrosis of hip. J Orthop Rep. 2023; 2:(1):100104. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9626405/
     [Google Scholar]
/content/journals/10.5339/qmj.2025.38
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The association of COVID-19 with the development of acute avascular necrosis of the head of the femur, apart from steroid usage
Qatar Medical Journal 2025, 38 (2025); https://doi.org/10.5339/qmj.2025.38
/content/journals/10.5339/qmj.2025.38
/content/journals/10.5339/qmj.2025.38
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  • Article Type: Research Article
Keyword(s): Avascular necrosis, COVID-19, retrospective study, risk factors and steroid use

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