It is well known now that COVID-19 can negatively influence different human body systems. Only few reports concerning avascular necrosis after COVID-19 have been accessible until now. The large-scale use of life-saving corticosteroids in COVID-19 treatment role is discussed in these papers. Four patients with bilateral avascular necrosis of the femoral head after being treated for COVID-19 infection are demonstrated. The doses of prednisolone used in three cases were 4000 mg, 746 mg and 533 mg. Сorticosteroids were not used for the treatment of one patient. Our data shows that the timing of the development of avascular necrosis after COVID-19 is significantly shorter than the terms of the osteonecrosis development in patients without COVID infection. Two patients out of four (sisters, 32 and 30 years old, 533 mg prednisolone dose and no corticosteroids) have burdened familial history (myocardial infarction, hypertension, thrombosis). Probably in these two sisters, hereditary vascular factors played some role in the genesis of avascular necrosis of femoral head. Further accumulation of evidence is needed to understand the characteristics of osteonecrosis after COVID-19. It is possible that several factors synergistically affect the development of this disease.
Non traumatic osteonecrosis of the femoral head is one of the leading causes of hip function loss in young patients. At the late stages of this disease the only way to restore motor activity is total hip arthroplasty. Literature review presents the systematic analysis of the most significant causes of this disease (long-term intake of corticosteroids, alcohol abuse, thrombophilia). Pathogenetic mechanisms of femoral head vascularization disturbance are considered. In recent decades the fundamental genetic studies enabled to establish that pathogenesis of femoral head osteonecrosis is based on the polymorphisms of genes that ensure coagulation cascade, and angiogenesis disturbance.
Introduction Non-traumatic avascular necrosis of the femoral head (ANFH) is a poly-etiologic and socially significant disease in the age of 20 to 50 years and is associated with disability. Research on the identification of necrosis causes/predictors is a relevant issue. Purpose To study the contribution of polymorphisms in the genes of coagulation factors F7 and F13 in the aetiology of non-traumatic avascular necrosis of the femoral head. Methods Polymorphisms of the genes of coagulation factors F7 and F13 were studied; comparative analysis of the frequency of important allelic variants of F7genes (Arg353Gln) and F13 (Val134Leu) in patients with a verified diagnosis of aseptic necrosis (study group) and in healthy patients (control group) was performed. The study group included 41 patients (all males) with aseptic necrosis of the femoral head of unknown etiology. Results The frequency of gene alleles in the F7 Arg353Gln in the study group were: GG in 30 out of 41 patients (73.2 %), GA in 11 out of 41 patients (26.8 %), and none of 41 patients had a polymorphic variant AA. The frequency of alleles of this type of gene in the control group was as follows: GG in 7 out of 320 subjects (2.2 %), GA in 66 out of 320 patients (20.6 %), AA in 247 out of 320 (77.2 %). Significant differences were identified in the frequencies of homozygous genotypes, AA (χ2 = 100.215, p < 0.001) and GG (χ2 = 205.770, p < 0.001) in the study and control groups respectively. As for the heterozygous GA genotype, the differences were not significant (χ2 = 0.834, p = 0.362). The GG genotype of the gene Val134Leu F13 WAS 2.8 times more frequent in patients of the study group, differences were statistically significant (26.8 % against 9.7 %, χ2 = 10.388; p = 0.002). The presence of the TT genotype of the gene Val134Leu F13 was almost five times more frequent (χ2 = 18.956, p < 0.001) in healthy individuals (control group). Differences in the frequency of allele T in homo/ and heterozygous combinations (TT and GT) in the study and control groups was also significant (72.7 % vs 90.1 %, respectively, χ2 = 4.946, p = 0.027). Discussion Polymorphisms of coagulation factors genes F7 and F13 have a significant effect on the genesis of non-traumatic avascular necrosis of the femoral head. Risk factor of ANFH development is homozygous GG genotype in the gene Arg353Gln F7. Low probability of the disease is due to a protective role of AA genotype of the gene Arg353Gln F7 and TT genotype of the gene Val134Leu F13.
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