Avascular Necrosis Bone Complication after Active COVID-19 Infection: Preliminary Results

Sulewski, Adam; Sieroń, Dominik; Szyluk, Karol; Dąbrowski, Mikołaj; Kubaszewski, Łukasz; Lukoszek, Dawid; Christe, Andreas

doi:10.3390/medicina57121311

Cited by 35 publications

(46 citation statements)

References 25 publications

(37 reference statements)

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“…Of these proposed mechanisms, a hypercoagulable state in itself has been documented to be a risk factor for the development of osteonecrosis 18 . From their case series of 10 patients, Sulewski et al concluded that COVID-19 infection alone might represent a risk factor for the development of osteonecrosis of the femoral head 19 . Symptomatic osteonecrosis of the knees has also been reported in patients who have recovered from COVID-19 20 .…”

Section: Discussionmentioning

confidence: 99%

Bisphosphonates for Post-COVID Osteonecrosis of the Femoral Head

Agarwala¹,

Vijayvargiya²,

Sawant³

et al. 2022

JBJS Open Access

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Background:COVID-19 infection can cause long-term effects, cumulatively known as long COVID syndrome. One such sequela is osteonecrosis of the femoral head (also called avascular necrosis of the femoral head, or AVNFH). On the basis of our 20-year experience in using bisphosphonate therapy in the successful management of osteonecrosis, we conducted the present study to evaluate the efficacy of the therapy in the management of post-COVID osteonecrosis of the femoral head. In addition, we aimed to evaluate the cumulative dosage of corticosteroids and the duration between the commencement of corticosteroids and the development of osteonecrosis in COVID-19 survivors.Methods:This was a retrospective evaluation of 48 patients (88 hips) diagnosed with osteonecrosis of the femoral head at a tertiary care center after COVID-19 infection between September 2020 and May 2021. Patients received intravenous zoledronic acid (5 mg) at the initiation of therapy and oral alendronate (35 mg) twice weekly, and were followed for a minimum of 6 months. Clinical evaluation was conducted using a visual analog scale (VAS) for pain and the Harris hip score (HHS). Radiographic evaluation was performed to assess the progression of the disease and collapse of the femoral head.Results:At a mean follow-up of 10 months, 84 (95.5%) of the hips showed good clinical outcomes, and only 4 (4.5%) of the hips required surgical intervention. The mean VAS pain score and HHS improved at 6 weeks and steadily improved on subsequent follow-ups. In 16 (18%) of the 88 affected hips, radiographic progression was observed. The mean dose of corticosteroids administered to the patients to manage COVID-19 infection was 841.3 mg of prednisolone equivalents. The mean duration between the commencement of corticosteroid therapy and the development of osteonecrosis was 179 days.Conclusions:Post-COVID osteonecrosis appears to be more aggressive, with COVID-19 itself contributing to its etiopathogenesis in addition to corticosteroids. However, it can be diagnosed by magnetic resonance imaging (MRI) in symptomatic patients and then effectively treated medically, especially if detected in the early stages.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Bisphosphonates for Post-COVID Osteonecrosis of the Femoral Head

Agarwala¹,

Vijayvargiya²,

Sawant³

et al. 2022

JBJS Open Access

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“…It may be this prothrombic state that led to a veno-occlusive state in our patient. There are only a small number of case reports with similar findings of femoral AVN following a COVID-19 infection [6]. Only two of those showed bilateral AVN and none with such delayed presentation resulting in bilateral femoral neck fractures [7].…”

Section: Discussionmentioning

confidence: 99%

Avascular Necrosis of the Hip: A Post COVID-19 Sequela

Kingma¹,

Hoch²,

Johnson³

et al. 2022

Cureus

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A 60-year-old African American male presented to the hospital with seven months of progressively worsening left anterior hip pain with no known trauma. Two months after the pain onset, he underwent an x-ray of the pelvis with the lateral left hip, revealing dystrophic soft tissue calcification adjacent to the superolateral left acetabulum. Pain at this time was attributed to presumed sciatica vs arthritis. The patient underwent multimodal treatment for his pain without relief. In the month prior to the presentation, the patient also developed right hip pain. He then underwent a bilateral hip x-ray, revealing left femoral neck lucency suspicious for a nondisplaced fracture. CT pelvis was ordered at this time for further evaluation and demonstrated bilateral subcapital hip fractures. He was subsequently discharged from the emergency department with pending laboratory work and plans for close outpatient orthopedic surgery follow-up. The following day, the patient was instructed to return to the hospital due to an elevated erythrocyte sedimentation rate of 39 mm/hr and C-reactive protein of 41.6 mg/L. Subsequent MRI pelvis revealed bilateral subcapital femoral neck fractures with avascular necrosis (AVN) requiring surgical intervention with bilateral hip arthroplasty. Our patient underwent an extensive workup with no evidence of traditional risk factors for osteonecrosis, osteopenia, or other bone diseases. A pertinent finding in the patient's history was an admission for severe SARS-CoV-2 (COVID-19) infection 10 months prior. 'Long COVID' is a complex illness that has been shown to affect intravascular blood flow, and likely contributed to the development of bilateral hip AVN in our patient. Given this novel presentation, it is crucial that AVN be considered early in evaluating anterior hip pain for patients with a history of COVID-19 infection in order to avoid severe consequences such as femoral neck fractures.

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“…Patients with systemic lupus erythematosus (SLE), solid organ transplants, hematological diseases, multiple sclerosis, and recent neurosurgery have higher prevalence of steroid induced osteonecrosis [ 49 ]. Severe acute respiratory syndrome and SARS-CoV-2 infections (i.e., COVID-19) also puts patients at risk for developing osteonecrosis [ [49] , [50] , [51] , [52] ]. In one study in SLE, a prednisone-equivalent dosage greater than 30–40 mg/daily or a cumulative dose ≥12 g/year conferred a significant risk of osteonecrosis while in patients undergoing kidney transplantation, the dose of systemic glucocorticoids in the first weeks was more important than the total cumulative dose.…”

Section: Risk Factorsmentioning

confidence: 99%