Concomitant septic arthritis of the hip joint and femoral head avascular necrosis in patients with recent COVID-19 infection: a cautionary report

Abstract

Purpose At present, concomitant avascular necrosis (AVN) of femoral head and septic arthritis (SA) as a sequel of COVID-19 infection has yet not been documented. By large-scale use of life-saving corticosteroids (CS) in COVID-19 cases, our aim is to warn of the occurrence of hip joint infection in these patients. Methods We report a series of five cases in which patients developed septic arthritis concomitant with AVN after being treated for COVID-19 infection. The mean dose of prednisolone used in these cases was 1695.2 mg. The time period of onset of hip symptoms in our cases from the beginning of the COVID-19 infection was 56 days in the first case, 43 days in the second case, 30 days in the third case, 29 days in the fourth case and 50 days in the last case, with an average time of 41.6 days. All patients underwent surgery depending on the extent of articular cartilage damage by direct anterior approach. Results Clinical and laboratory symptoms improved significantly in all patients. The mean visual analogue pain score of the patients decreased from 9.4 (9–10) before surgery to 2.8 (1–4) after 1 week of operation. Conclusion In any patient with the history of COVID-19 infection specially those who have been treated with corticosteroid as one of the medications prescribed during the disease, any joint symptom specially in the hips should draw our attention to the joint infection, and with timely diagnosis and surgery, their hip joint can be saved.

Femoral head avascular necrosis in COVID-19 survivors: a systematic review

“…Reporting the details on the severity of the disease and the need for ICU admission varied among the included reports. The details of the medical management were mentioned in seven reports [ 19 – 21 , 23 , 25 , 29 , 30 ], which included steroids, antivirals, antibiotics, biologics, and anticoagulants. In all reports, corticosteroids were used in the management plan except for one [ 15 ], where no steroids were used for any of the patients.…”

Two Cases of COVID-Related Osteonecrosis of the Jaws: A New and Worrying Entity Is Emerging

“…The number of reports of CRONJ in other bones is slightly higher. Most notably knee 6 , 7 , 14 , 15 , hip 14 , 16 , femoral head 16 - 20 , and spine 21 . General musculoskeletal manifestations have also been reported 22 - 24 .…”

Post-Acute COVID-19 Joint Pain and New Onset of Rheumatic Musculoskeletal Diseases: A Systematic Review

“…Regarding the prevalence of RF and ACPA, largely inconsistent results were found, precluding the possibility to draw conclusions. Interestingly, besides arthralgia or inflammatory rheumatic diseases, a few cases of avascular necrosis of the femoral head or of transient osteoporosis of the hip have been described, suggesting potential vascular implications caused by the endothelial dysfunction induced by SARS-CoV-2 [30,87,88]. The early recognition of patients at higher risk of developing post-COVID-19 musculoskeletal diseases could lead to a better treatment of these conditions.…”

“…Ardakani et al described 5 patients developing septic arthritis with concomitant avascular necrosis of the femoral head, on average 42 days after the infection [30], while performing 18F fluorodeoxyglucose (FDG) positron emission tomography (PET) on 13 post-COVID-19 patients, Kiatkittikul et al showed radiotracer uptake in the skeletal muscle of 8 patients (62%), compatible with myositis [50].…”