Abstract: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 c… Show more
The current systematic review aimed to document published cases of femoral head avascular necrosis (FHAVN) post-COVID-19, to report the COVID-19 disease characteristics and management patients received, and to evaluate how the FHAVN were diagnosed and treated among various reports. A systematic literature review was performed per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines through a comprehensive English literature search on January 2023 through four databases (Embase, PubMed, Cochrane Library, and Scopus), including studies reporting on FHAVN post-COVID-19. Fourteen articles were included, ten (71.4%) were case reports, and four (28.6%) case series reported on 104 patients having a mean age of 42.2 ± 11.7 (14:74) years, in which 182 hip joints were affected. In 13 reports, corticosteroids were used during the COVID-19 management plan for a mean of 24.8 ± 11 (7:42) days, with a mean prednisolone equivalent dose of 1238.5 ± 492.8 (100:3520) mg. A mean of 142.1 ± 107.6 (7:459) days passed between COVID-19 diagnosis and FHAVN detection, and most of the hips were stage II (70.1%), and concomitant septic arthritis was present in eight (4.4%) hips. Most hips (147, 80.8%) were treated non-surgically, of which 143 (78.6%) hips received medical treatment, while 35 (19.2%) hips were surgically managed, 16 (8.8%) core decompression, 13 (7.1%) primary THA, five (2.7%) staged THA and three (1.6%) had first stage THA (debridement and application of antibiotic-loaded cement spacer). The outcomes were acceptable as regards hip function and pain relief. Femoral head avascular necrosis post-COVID-19 infection is a real concern, primarily attributed to corticosteroid usage, besides other factors. Early suspicion and detection are mandatory, as conservative management lines are effective during early stages with acceptable outcomes. However, surgical intervention was required for progressive collapse or patients presented in the late stage.
The current systematic review aimed to document published cases of femoral head avascular necrosis (FHAVN) post-COVID-19, to report the COVID-19 disease characteristics and management patients received, and to evaluate how the FHAVN were diagnosed and treated among various reports. A systematic literature review was performed per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines through a comprehensive English literature search on January 2023 through four databases (Embase, PubMed, Cochrane Library, and Scopus), including studies reporting on FHAVN post-COVID-19. Fourteen articles were included, ten (71.4%) were case reports, and four (28.6%) case series reported on 104 patients having a mean age of 42.2 ± 11.7 (14:74) years, in which 182 hip joints were affected. In 13 reports, corticosteroids were used during the COVID-19 management plan for a mean of 24.8 ± 11 (7:42) days, with a mean prednisolone equivalent dose of 1238.5 ± 492.8 (100:3520) mg. A mean of 142.1 ± 107.6 (7:459) days passed between COVID-19 diagnosis and FHAVN detection, and most of the hips were stage II (70.1%), and concomitant septic arthritis was present in eight (4.4%) hips. Most hips (147, 80.8%) were treated non-surgically, of which 143 (78.6%) hips received medical treatment, while 35 (19.2%) hips were surgically managed, 16 (8.8%) core decompression, 13 (7.1%) primary THA, five (2.7%) staged THA and three (1.6%) had first stage THA (debridement and application of antibiotic-loaded cement spacer). The outcomes were acceptable as regards hip function and pain relief. Femoral head avascular necrosis post-COVID-19 infection is a real concern, primarily attributed to corticosteroid usage, besides other factors. Early suspicion and detection are mandatory, as conservative management lines are effective during early stages with acceptable outcomes. However, surgical intervention was required for progressive collapse or patients presented in the late stage.
“…The patients can be advised to use assistive devices such as walker and cane(s) during mobilization. In terms of pharmacological therapy, bisphosphonates can be used for the early stages of post-COVID osteonecrosis of the femoral head [6]. Assad et al, in their 17-patient-report used conservative treatment in nine cases (53%) and surgical treatment (core decompression was performed in five cases, total hip replacement in three) for the rest [4] 6 months.…”
Section: Discussionmentioning
confidence: 99%
“…The mean follow-up was 10 months. Of the 88 hips, 95.5% showed good clinical response to bisphosphonate treatment, 4.5% of the hips required surgical intervention [6]. A systematic review by Hassan and Khalifa evaluated how the diagnoses and management of post-COVID-19 femoral head avascular necrosis among various reports.…”
Avascular necrosis of the femoral head can traumatic or non-traumatic in origin. Embolism (hemoglobinopathies, dysbaric osteonecrosis), corticosteroid treatment, alcohol usage, pelvic irradiation, and genetic susceptibility are among the causes of this clinical entity. Pathogenesis is influenced by thrombophilia, hypofibrinolysis, and hypoangiogenesis. Coronavirus disease 2019 (COVID-19) infection stands as a cause of non-traumatic osteonecrosis of the femoral head. The condition can be related to the use of corticosteroids throughout the disease course of COVID-19. Yet, there could be other disease-related factors that may contribute to the development of osteonecrosis of the femoral head. The current article aimed to present a case with COVID-19 associated avascular necrosis of the femoral head.
“…The management of this condition is varied; however, this study from Mumbai (India) details the authors’ experience of using bisphosphonates in doing just that, alongside an analysis of the effect of corticosteroids used in managing COVID-19 illness on the hip. 4 Overall, 88 hips were evaluated between September 2020 and May 2021. Patients were treated as a first line with zolendronic acid and oral alendronate for a minimum of six months.…”
Section: Bisphosphonates For Post-covid-19 Osteonecrosis Of the Femor...mentioning
confidence: 99%
“…The management of this condition is varied; however, this study from Mumbai (India) details the authors' experience of using bisphosphonates in doing just that, alongside an analysis of the effect of corticosteroids used in managing COVID-19 illness on the hip. 4…”
Section: Bisphosphonates For Post-covid-19 Osteonecrosis Of the Femor...mentioning
The April 2023 Research Roundup360 looks at: Ear protection for orthopaedic surgeons?; Has arthroscopic meniscectomy use changed in response to the evidence?; Time to positivity of cultures obtained for periprosthetic joint infection; Bisphosphonates for post-COVID-19 osteonecrosis of the femoral head; Missing missed fractures: is AI the answer?; Congenital insensitivity to pain and correction of the knee; YouTube and paediatric elbow injuries.
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