Undiagnosed Bilateral Avascular Necrosis of the Femur in a Young Male Caused by COVID-19 Steroid Injections

Abstract

Osteonecrosis is a degenerative bone disease brought on by a change in subchondral blood flow and characterized by the loss of bone cellular components. Other names for it include ischemic bone necrosis, aseptic necrosis, and avascular necrosis. Long bones' epiphyses in weight-bearing joints are typically impacted. In extreme cases, a joint may completely collapse or subchondral bone may be obliterated. Avascular necrosis, which most frequently affects joints, especially the femoral head, occurs when the blood supply to the bones is diminished. In this article, we will explain the clinical case of a 40-year-old man who's been complaining about hip pain for two months. The patient went to Acharya Vinobha Bhave Rural Hospital (AVBRH) with the same complaint and underwent some tests; upon inspection, it was discovered that the patient had bilateral avascular femoral head necrosis. For avascular necrosis (AVN) of the left femoral head, the patient had core decompression surgery. Once post-operative physical therapy was initiated, the condition significantly improved, and it also served to prevent additional abnormalities. The goal of this case study is to examine the therapeutic strategies essential for treating bilateral femoral head avascular necrosis.

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

“…The laterality of the affected side was reported in all articles except for one [ 18 ], 37 bilateral, and 16 unilateral hip affection. The time interval between being diagnosed with COVID-19 infection and FHAVN detection was reported in all studies except for one [ 24 ], having a mean of 142.1 ± 107.6 (7:459) days. FHAVN staging was reported in 174 hips from 12 reports [ 15 , 18 – 28 ], which was divided into 16 (9.2%) stage I, 122 (70.1%) stage II, 24 (13.8%) stage III 12 (6.9%) stage IV.…”

“…Thirty-five (19.2%) hips were surgically managed, 16 (8.8%) were treated by core decompression [ 20 , 24 , 25 , 27 , 28 , 30 ]; a concomitant bone graft or bone marrow aspirate was injected in four [ 27 , 30 ], and a concomitant medical treatment was accompanied in two [ 27 ]. First stage THA (debridement and application of antibiotic-loaded cement spacer) was performed in three (1.6%) hips [ 21 ].…”

Who is the convict; COVID‐19 or corticosteroid? Late onset avascular necrosis of hips after COVID‐19. A case report with literature review

“…34 After the COVID-19 pandemic, there are some case reports and case series of AVN related to COVID-19. [11][12][13][14][15][16][17][18][19][20][21] In COVID-19 patients, multiple mechanisms, such as endothelial dysfunction, clot formation, and corticosteroid consumption, may occur simultaneously, which all lead to bone infarct or osteonecrosis. The prevalence of AVN related to COVID-19 was reported to be around 0.07%.…”

“…It seems that in COVID‐19 patients, multiple mechanisms, such as endothelial dysfunction, clot formation, and corticosteroid consumption, may occur simultaneously, which all lead to bone infarct or osteonecrosis. There are some case reports of AVN related to COVID‐19 around the world 11–21 . Data have shown that AVN in COVID‐19 develops in shorter time compared with this pathology in patients without COVID‐19 22 .…”

A New Horizon in Hip Health: Using an Innovative Variable Loop Curette for Core Decompression and Bone Marrow Aspirate Concentrate in the Management of Pre-collapse Avascular Necrosis of the Hip

“…To safeguard the femoral head and delay arthroplasty as much as possible, it is vital to intervene in the early stages of the disease's development. According to Kamani et al found that the effects of COVID-19 on steroidal injections led to the development of bilateral AVN of the femoral head in a young male [ 3 ]. This condition impeded his daily activities and posed challenges in managing the undesirable side effects of steroidal injections [ 4 ].…”