AVASCULAR NECROSIS OF THE FEMORAL HEAD – NOT TO BE OVERLOOKED SEQUELA AFTER COVID 19 INFECTION

BackgroundCOVID 19 infection could lead to different sequelae in survivors, known as post-COVID or long COVID 19 syndromes. Some of them are thought to be due to the thrombophylic changes observed in COVID 19 infection, but some are thought to be caused by the administrated (especially high dose) corticosteroid treatment. Avascular necrosis of the femoral head (AVNFH) is a multifactorial disease which leads to compromised vascular supply, ischemia and finally necrosis of the femoral head. As corticosteroids usage and thrombophylic states are among the main known risk factors for the development AVNFH [1], it could be presumed that the frequency of this disease will increase with the COVID 19 pandemic. The exact corticosteroid dose needed for the development of AVNFH is not clear, but it has been stated that a higher daily dose and a larger total cumulative dose increase substantially the risk for the development of osteonecrosis [2].ObjectivesTo describe in detail the characteristics of AVNFH diagnosed in patients after COVID 19 infection.MethodsThe study was done in a tertiary university rheumatological clinic. Data was extracted from the records of patients who have been referred to the clinic because of hip pain between June and December 2022. Inclusion criteria were: - a new onset of uni-or bilateral hip pain that started after a documented COVID 19 infection;and an MRI scan of the hip joints showing osteonecrosis of one or both femoral heads. Exclusion criteria were the presence of hip pain prior to the COVID 19 infection, anamnesis of traumatic injuries of the hips or pelvis, personal history of hypercoagulable states.ResultsNine patients (4 women and 5 men) with an average age 59.1 years (range 38-72) were included in the study. Four patients had been diagnosed with bilateral and five – with unilateral AVNFH, thus 13 hip joints were analysed in total (8 left and 5 right sided). The mean time lap between the COVID 19 infection and the start of the hip pain was 26.2 weeks (range 10-48 weeks). All patients had limited and painful movement in their symptomatic hip(s), especially internal rotation and four of the patients had also elevated CRP levels (mean 11.7 mg/L). The stage of the AVNFH was evaluated according to the Ficat-Arlet classification (0-IV stage). In four hips the AVNFH was stage I, five hips were classified as stage II and the remaining four joints - as stage III. All symptomatic hip joints exhibited effusion/synovitis on both ultrasound examination and the corresponding MRI scan. It should be noted that the presence of hip effusion was found to be related with a worse prognosis in AVNFH [1]. In three patients the amount of the effusion required arthrocentesis and fluid aspiration. The analysis of the joint fluid was consistent with a degenerative disease (i.e., low WBC count with predominant lymphocytes and no crystals). All patients included in our study had received corticosteroids during their COVID19 infection, while 6 of the patients had also been hospitalized due to more severe disease. According to the patients' documentation, the mean cumulative dose of the received corticosteroids was 936.2 mg prednisolone equivalent per patient (range 187-2272 mg).ConclusionAVNFH must not be overlooked in a new onset hip pain after COVID 19 infection. Our results show that corticosteroids administrated during the infection and the presence of hip joint effusion on ultrasound are especially suggestive for the development of osteonecrosis, as they were registered in all of our patients. The presence of these two factors necessitates patient referral for an MRI scan of the hips, in order that AVNFH be detected timely.References[1]Petek D, Hannouche D, Suva D. Osteonecrosis of the femoral head: pathophysiology and current concepts of treatment. EFORT Open Rev. 2019 Mar 15;4(3):85-97.[2]Kerachian MA, Séguin C, Harvey EJ. Glucocorticoids in osteonecrosis of the femoral head: a new understanding of the mechanisms of action. J Steroid Biochem Mol Biol. 2009 Apr;114(3-5):121-8.Acknowledgements:NIL.Disclosur of InterestsPLAMEN TODOROV Speakers bureau: speaker at national level for AbbVie, Novartis and UCB, Lily Mekenyan: None declared, Anastas Batalov Speakers bureau: Speaker at national level for AbbVie, Novartis, Pfizer, Stada, Elly Lilly.

Rare localization of avascular necrosis during treatment of COVID-19 with glucocorticosteroids

The development of bony avascular necrosis induced by glucocorticoid treatment of COVID-19 is a common adverse effect, with femoral head being the most commonly affected. Timely detection of avascular necrosis is important in the prevention of osteoarthrosis and other complications. We present a clinical case of a 54-year-old patient hospitalized for novel coronavirus infection with complaints of severe pain in both knees 2 weeks after the disease onset. Magnetic resonance imaging revealed pronounced changes in both knees, corresponding to avascular necrosis. The results of conservative therapy, including non-steroidal anti-inflammatory drugs and bisphosphonate bone resorption inhibitors, produced a pronounced positive result. At follow-up examination 3 months later, there was no pain, but the knee joints still had slight restrictions of movement. Magnetic resonance imaging showed a significant decrease in the previously detected changes. The side effects of glucocorticoids (impaired glucose tolerance, increased blood pressure, tachycardia, gastrointestinal erosive ulcers, sleep disorders, etc.) are widely known, but knee osteonecrosis caused by steroid intake rarely comes to the attention of clinicians. This clinical case emphasizes the complex nature of osteonecrosis pathogenesis and demonstrates a wide range of complications in corticosteroid therapy. © 2022, Eco-Vector LLC. All rights reserved.

MULTIFOCAL OSTEONECROSIS AS A CONSEQUENCE OF A NEW CORONAVIRUS INFECTION.

The impact of the transferred coronavirus infection on the musculoskeletal system still remains an urgent problem. Arthralgia, myalgia, arthritis, autoimmune disorders and also osteonecrosis are may be development of the post-COVID period. This article discusses the case of the debut of multifocal osteonecrosis after a coronavirus infection.Copyright © 2023 Ima-Press Publishing House. All rights reserved.

Spontaneous Avascular Necrosis of the Humeral Head Following COVID-19 Vaccination.

We report a case of a 40-year-old man who presented with left shoulder pain and marked functional impairment two days after receiving the second dose of the Pfizer COVID-19 vaccine. Advanced imaging demonstrated focal avascular necrosis (AVN) of his humeral head. Initial management included simple analgesics, activity modification, and an ultrasound-guided intra-articular hydrodilatation injection. The patient subsequently had an improved range of motion but persistent severe shoulder pain. He has now been offered surgical intervention. Despite having risk factors for developing AVN previously, the patient did not demonstrate any recent risk factors for developing the disease. COVID-19 vaccination is known to cause severe joint pain and stiffness rarely. However, avascular necrosis is not a known or documented side effect. His symptoms arose directly after the administration of the vaccine, with no other demonstrable cause. Therefore, we are reporting COVID-19 vaccination as a potential new risk factor for AVN of the humeral head.

AVASCULAR NECROSIS OF HIP AFTER ACTIVE COVID-19 INFECTION

Background and objectives: The course of SARS-CoV-2 (COVID-19) is still under analysis. The majority of complications arising from the infection are related to the respiratory system. The adverse effect of the viral infection on bone and joint tissue has also been observed. Materials and Methods: We present a group of 10 patients with degeneration of hip, with a background of avascular necrosis (AVN) immediately after infection with the COVID-19 virus. In MR imaging, changes in the characteristics of AVN were documented. Results: Observation of this group showed a clear correlation among the history of COVID-19 disease in the patients, moderately severe symptoms, high levels of IgG antibodies, and the time of occurrence of joint changes. No other clinically significant complications were observed following COVID-19 infection in the study group. No other risk factors for AVN or autoimmune or degenerative diseases were found in the study group. The group of patients responded well to empirical treatment with steroids, which normalized acute inflammatory symptoms and pain in the joints. Conclusions: During coronavirus (COVID-19) infection, there are complications in the locomotor system, such as microembolism and the formation of AVN;hence, more research is needed. [ FROM AUTHOR] Copyright of Journal of Cardiovascular Disease Research (Journal of Cardiovascular Disease Research) is the property of Journal of Cardiovascular Disease Research and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

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

AIM: Avascular necrosis (AVN) or osteonecrosis is characterized by death of bone tissue due to endothelial damage and vascular abnormality. Coronavirus can induce endothelial damage and abnormal blood clotting, so that COVID-19 is known as a vascular disease. We aim to evaluate the relationship between AVN and COVID-19. CASE: Here we present a 39-year old man with severe COVID-19 and corticosteroid consumption who developed late onset AVN of both hips 20 month after COVID-19. CONCLUSION: An awareness of the possible osteonecrosis for all physicians dealing with patients with musculoskeletal problems following COVID-19 is necessary.

Avascular Necrosis of the Hip Triggered by COVID-19 Infection in a Patient with Sickle Cell Disease: A Case Report.

Introduction: The COVID-19 pandemic has affected many people around the world with its primary and secondary consequences. The use of high-dose steroids in its treatment brought along steroid-related femoral head avascular necrosis (AVN) complication. Case Presentation: We present a case of bilaterally developed femoral head AVN following COVID-19 infection in a patient with sickle cell disease (SCD), without the history of steroid use. Conclusion: With this case report, we aimed to raise awareness that COVID-19 infection may trigger AVN of the hip joint in SCD patients.

Avascular necrosis in pediatric mandibular distraction - Report of a rare complication with a review on the pathogenic mechanism and management strategies

Avascular osseo-necrosis is one of the rare complications that has never been reported in pediatric mandibular distraction. However extensive periosteal stripping, developing tooth buds and aberrations related to the inferior alveolar canal in malformed syndromic mandible may lead to compromised vascularity to the osteotomised segments leading to avascular necrosis after monofocal mandibular distraction. The aim of the current case report is to describe this rare complication after pediatric MMDO and discuss in detail the possible etio-pathologic mechanisms and provide an insight for the management strategies.Copyright © 2021 The Authors

Avascular Necrosis as a Sequela of COVID-19: A Case Series.

Avascular necrosis (AVN) is a degenerative bone condition characterized by cellular death and bone collapse from compromised subchondral blood circulation. AVN begins with vascular interruption, hypertension, intravascular occlusion, or extravascular compression which reduces bone circulation. Although corticosteroids are frequently used to treat acute COVID-19 infections, patients are prone to its side effects, particularly AVN. Furthermore, COVID-19 produces coagulopathies, specifically hypercoagulability, that may contribute to venous thrombosis, which may serve as the impetus of AVN. While the literature discussing COVID-19, AVN, and corticosteroid use is not conclusive, patients being treated with corticosteroids for COVID-19 are at an increased risk for AVN possibly due to the combination of COVID-19 infection and corticosteroid use, or the use of high-dose steroids alone. The purpose of this case series is to elucidate AVN as a long-term sequalae of COVID-19, describe our management of COVID-19 and steroid-induced AVN, and discuss the current literature regarding AVN and COVID-19. Three patients hospitalized for COVID-19 infections were treated with corticosteroids and subsequently developed AVN. All patients, but one, had multiple sites of infarction and were treated with core decompression in the hip where there was no collapse of the subchondral bone. One of these patients had multiple infarcts in bilateral femoral heads, femoral shafts, and knees. This patient had a history of end-stage renal disease, and, therefore, total knee replacement was postponed until medical clearance. Core decompression was performed on the femoral head that showed no collapse to delay osteoarthritis of the hip. Multiple articles in the current literature support the idea that the combination of COVID-19 and corticosteroid use increases the risk of AVN and reduces the onset of COVID-19-related respiratory symptoms. The patient cases discussed in this case series suggest a possible association between COVID-19, corticosteroid use, and AVN.

Covid-19 Medications and Its Post Effects

Till date, over 163 million confirmed cases of COVID-19 and over 3.3 million deaths from COVID-19 have been reported by the World Health Organization (WHO). However, there is still no specific treatment for the disease. Some empirical and supportive medications have been used thus far, including antivirals, antipyretics, antibiotics, and corticosteroids. Corticosteroids are anti-inflammatory and immunosuppressive medications that are used to treat several diseases. These agents can produce undesirable and occasionally severe systemic adverse effects. Although the occurrence and severity of most adverse effects are related to the dose and duration of the corticosteroid therapy, avascular necrosis is not directly associated with this dose and duration, and may occur without osteoporosis. The basis of the use of such corticosteroid drugs in patients suffering from COVID-19 is the immunosuppressant nature of the drugs Corticosteroids are not recommended for routine use in COVID-19 patients by the WHO. But it is widely used by many people for treating this condition. Severe COVID-19 patients are at risk of avascular necrosis due to corticosteroid therapy Avascular necrosis is a progressive and incapacitating condition. The causes of avascular necrosis are categorized into traumatic and non-traumatic. The majority of non-traumatic cases are associated with the use of corticosteroids. Popular corticosteroid drugs and therapies that are being prescribed in patients suffering from COVID-19 are dexamethasone, methylprednisolone and or hydrocortisone with IV (intravenous) and/or oral administration. The use of such high doses of corticosteroids have shown very positive results and have been lifesaving in many cases.

Corticosteroids Induced Avascular Necrosis of Hip, a "Long Covid-19" Complication: Case Report

Since it first surfaced, the new Coronavirus has multiplied and mutated into different forms, leading to a significant impact on people's lives. COVID-19's long-term impact is not completely known: It can only be hypothesized based on the prior outbreak of severe acute respiratory syndrome (SARS). Avascular necrosis (AVN) is one of these consequences, which if left untreated can lead to catastrophic events and bone collapse. It's important to remember that individuals who have recovered from COVID-19 infection are still at risk of developing AVN. The pathological findings in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are very similar to those seen in severe acute respiratory syndrome coronavirus (SARS-CoV) infection. We present cases of 27- and 69-years old men with no comorbidities admitted with complaints of bilateral hip pain post Covid treatment with corticosteroids and antivirals. The diagnosis was established based on history, physical examination, and magnetic resonance imaging (MRI). The use of corticosteroids in the treatment of SARS-CoV-2 infection has saved many lives, and it is still advised for moderate to severe cases on a short-term basis. The long-term use of corticosteroids is associated with numerous side effects. One of the most prevalent side effects of steroids is avascular necrosis of the femoral head, which is aggravated by the disease process. Early detection of avascular necrosis is very crucial in its management due to its high progression rate. Low therapeutic doses of corticosteroids with minimal effective duration remain the key to halting its occurrence.

All in the Marrow - a Case of Primary Bone Marrow Oedema

Introduction/Background: Primary bone marrow oedema syndrome is an elusive and less well-defined entity. Whether Rheumatologists should consider it as a stand alone diagnosis, is debatable. It possibly would be best described as an MRI feature which could be a finding in a number of diseases which would include the initial phases of Osteonecrosis of the bone, Rheumatoid Arthritis, Spondyloarthritis, Enthesitis related, Post traumatic, OA, Infections and Cancers. The treatment options become constricted due to the paucity of evidence. Rheumatologists need to consider this as an area of unmet need with development of consensus classification criteria and treatment approaches. Description/Method: 27-year-old male, Height 174 cms Weight 90 Kgs BMI 29 Kg/m2, became symptomatic in Jan 2022 with complains of pain in the both hip joints & groin regions, pain became excruciating and he became bed-bound, with early morning stiffness lasting approximately 45 mins. Had received steroids for COVID infection in August 2020. Investigations Hb 13.5gm/dl TLC 7000/mm3 Platelet 400 x 103/mm3 Sr Bil 0.8mg/dl AST 16 IU/L. ALT 24 IU/L Sr Creatininine 1.1mg/dl Blood Sugar Levels, Fasting 89 mg/dl Post Prandial 102 mg/dl ESR 10mm in 1st hour by Wintrobes method CRP Quantitative 29.38mg/L HLA B27 by PCR Negative, RF Negative, ACCP Negative Serum, IgG, Beta2 Glycoprotein 1.44 SGU Serum, IgM, Beta2 Glycoprotein 3.44 SGU Serum, IgG, Cardiolipin antibody 8.4 GPL Serum, IgG, Cardiolipin antibody 17.45 GPL Lupus anticoagulant by DRVVT Negative Sr Cholesterol 211mg/dl HDL 29 mg/dl LDL 156mg/dl TGs 130 mg/dl MRI Hips & SI joints Transient bone marrow oedema/osteopenia of bilateral hip. PET CT Increased metabolic activity in both hip joints Bone Scan (99mTcMDP) Increased vascularity in perfusion phase, increased accumulation in soft tissue in blood pool phase and increased uptake in bilateral Hip joints in skeletal phase scan, suggestive of CRPS Type-I. Management Was initially managed with Tab Etoricoxib 90mg BD, also started on Tab Sulphaslazine and Tab Methotrexate. However, when he had no symptomatic relief he was administered Inj Infliximab on 12 May 2022 and a second dose on 9 June 2022. He had excellent pain relief after the 1st dose, however after 10 days of the administration, he again began experiencing pain especially after walking. He also had pain in the knees on this occasion. He was also administered Inj Zoledronic 4mg on 23 May 2022. He is at present not requiring any NSAIDs over the last 1 month. Discussion/Results: The patient having presented with excruciating and debilitating pain was worked up and evaluation revealed features of bone marrow oedema on MRI which was corroborated with bone scan and PET CT imaging. The acute phase reactant CRP was also significantly elevated. The patient also gave history of early morning stiffness lasting approximately 45 mins. Hence an underlying Inflammatory process such as Spondyloarthritis(Peripheral) with enthesitis was considered. The confounding factors were the pain which worsened on mobilization, HLA B27 negative status, Rheumatoid Factor and ACCP negative status and past history of having received IV Corticosteroids for COVID infection in August 2020. In view of the debilitating pain and aworking diagnosis of Spondyloarthritis, hewas started onNSAIDs alongwith rest, initially, followed by conventional synthetic disease modifying agents in Rheumatic disease followed by biologic synthetic diseasemodifying agent - Inj Infliximab. The thought process was to avoid prolonged NSAID use to prevent the associated side effects. However, since Avascular Necrosis of the Femoral head is a very likely possibility, the patient is planned to be kept under close follow up. Key learning points/Conclusion: Collaborative efforts between the Departments of Nuclear Medicine, Radiology, Orthopaedics and Rheumatology are crucial in the early detection and approach to cases of Bone Marrow oedema. Avascular necrosis of head of Femur is a far more common entity and must be kept in ind even when a diagnosis of Bone Marrow oedema syndrome is being entertained. Diagnosis of Bone Marrow oedema syndrome must be entertained only as a diagnosis of exclusion. Continued follow up and regular imaging must be pursued rigorously in patients diagnosed with Bone Marrow oedema syndromes. There is a requirement to document acute phase reactants such as CRP and ESR in patients diagnosed with Avascular necrosis of bone as this data could help us differentiate AVN from Primary Bone marrow oedema in the early stages.

Physiotherapy Rehabilitation Post Total Hip Replacement in the Case of Avascular Necrosis of the Femur: A Case Report.

Avascular necrosis of the femur is an irreversible and painful disorder in which the epiphyseal bone suffers from ischemia necrosis owing to an interruption in blood flow to the femoral head, resulting in bone destruction. Later, it leads to osteoarthritis of the hip joint. Here, we present the case of a 35-year-old male who came with a complaint of pain on the left side of the hip region for the past 15 days. Since the patient tested positive for COVID-19, he was quarantined. An X-ray was carried out once the quarantine period was completed, which revealed avascular necrosis of the left femoral head. He was advised to have a total hip replacement and underwent the surgery. After one month, the patient started experiencing pain on the right side of the hip region. He visited the rural hospital, where an X-ray was carried out, which revealed avascular necrosis of the right femoral head. For reducing pain and improving functional independence and quality of life postoperatively, a well-planned physiotherapy protocol was incorporated, which included lower limb and pelvic floor strengthening exercises and a balance training program. The Numerical Pain Rating Scale and Harris Hip Score have been used as outcome measures to demonstrate the efficacy of the treatment.

AVASCULAR NECROSIS OF THE EPIPHYSES OF BONES IN PATIENTS WHO HAVE HAD SARS-COV-2 INFECTION: CLINICAL OBSERVATIONS AND A NARRATIVE REVIEW OF LITERATURE DATA

The SARS-CoV-2 coronavirus pandemic is a leading medical problem that is in the focus of attention of representatives of all medical specialties. In addition to fighting the COVID-19 infection itself, the task of preventing and treating a wide range of complications arising after the disease is becoming increasingly urgent. One of these complications is avascular necrosis (AN) of bone tissue - a severe pathology that leads to serious suffering, a decrease in the quality of life and disability of patients. For the period from 2020 to 2022 there are 9 reviews in the world literature devoted to the pathogenesis, clinical features and treatment possibilities of this complication. During the same period, 5 articles were published describing clinical observations of AN after suffering COVID-19. The purpose of this work is to demonstrate our own clinical observations, as well as to review the available literature data on the problem of AN after COVID-19 infection. Based on the analysis, it can be concluded that AN after SARS-CoV-2 infection most often develops in the femoral head (>50% of cases), occurs regardless of the severity of the disease and the cumulative dose of glucocorticoids used in the acute period of the disease. It seems advisable to perform an MRI of the hip joints at least once every 3 months for all patients who have had COVID-19 in severe and moderate form during the first year after convalescence. Copyright © 2022 Ima-Press Publishing House. All rights reserved.

FEMORAL HEAD OSTEONECROSIS POST-COVID-19 INFECTION, A PROPHECY COMING TRUE. A REPORT OF SEVEN HIPS

Musculoskeletal complications following COVID-19 infection or because of its medications had been reported in the literature. Here, we report on seven hips in four patients who presented with osteonecrosis of the femoral head (ONFH) after having COVID-19 infection, and their treatment regimen included glucocorticoid. Four patients presented to us complaining of hip pain (bilateral in three patients and unilateral in one), all reported being diagnosed as having COVID-19 infection, and their line of management included corticosteroid intake for various durations. The diagnosis was confirmed by plain hip radiographs and magnetic resonance imaging. The disease was in the early stages in all patients without femoral head collapse. Thus, all hips were treated by core decompression. ONFH is a real concern in patients who have COVID-19 infection, especially when corticosteroids are administered as part of their management. A follow-up and screening strategy should be established for patients who had COVID-19 infection to detect the early development of hip osteonecrosis. [ FROM AUTHOR]

Rehabilitation of Person in a Barrel Syndrome Due to Sequela of Prolonged Intubation After COVID-19: A Case Report

Case Diagnosis: A 46-year-old male with severe COVID-19 pneumonia. Case Description or Program Description: The patient underwent bilateral orthotopic lung transplant (BOLT) after being on extracorporeal membrane oxygenation (ECMO) and mechanical ventilation for 202 days. He had multiple complications due to prolonged prone positioning, intubation, immobility and steroid use which include tongue fissure, critical illness neuromyopathy, bilateral brachial plexopathy, bilateral upper extremity contractures, avascular necrosis (AVN) of bilateral humeral heads and bilateral femoral heads, left sciatic mononeuropathy and a stage IV sacral wound. The patient had severe weakness throughout all limbs, but was cognitively intact. He was admitted to IPR 3.5 weeks after his BOLT. The patient was independent for ADLs and mobility prior to his illness and was dependent for activities of daily living (ADLs) and mobility at time of admission to inpatient rehabilitation (IPR). Setting(s): Inpatient rehabilitation hospital Assessment/Results: Following 12 weeks of IPR he ambulated independently and was discharged to the community with family assist in an outpatient Day Rehabilitation program for continued functional recovery. Unfortunately, he still required maximum assistance for ADLs due to loss of function of his arms. Discussion (relevance): This is a unique case of a patient with severe COVID-19 pneumonia who was intubated and on ECMO for a very long amount of time with survival ultimately leading to numerable sequela involving all extremities but notable injuries presenting as a person in a barrel type syndrome. Conclusion(s): Person in a barrel syndrome is a rare syndrome described by severe bilateral upper extremity weakness with strength preserved in the bilateral lower extremities as well as head, neck, and face. This patient developed this syndrome as a sequela to prolonged prone positioning and immobility related to severe COVID-19 disease. Consultation of PM&R services while in the ICU to aid in identification of patients at risk and help to optimize patient positioning without compromising life-saving procedures.

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

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.

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

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.

A retrospective study on covid 19 infection and avascular necrosis of hip

Background Musculoskeletal involvement was the least addressed area of post covid 19 infection sequela in literature even though they significantly reflect in mobility of survivors and ends up in morbidity. Emphasis on this grey area may enlighten further researches on the same.The study aims to identify the relationship between Covid 19 infection and avascular necrosis of femoral head, by retrospectively assessing the COVID 19 history of patients who attended a tertiary center. Materials and methods Study Period: 26/7/2021 – 26/7/2022).The data of all the patients diagnosed with avascular necrosis of hip during from 26/7/21 to 26/7/22were retrospectively assessed to identify the history of COVID 19. Results A total of 17 patients were available for the study,the mean age of the patients were 37 years (range 23-60). Out of the 17 patients 7 were female and 10 were male. All the patients were presented to the OPD with hip pain.On assessing the history of COVID 19 it was found that out of the total 17 patients, 14 had history of COVID 19 infection (82.4%).On detailed history assessment, it was also found that all the 14 post Covid patients had their symptoms onset after COVID.The retrospective analysis of the AVN patients over the study period of one year indicates that the 82.4% of the patients had history of COVID prior to the onset of AVN symptoms, with average duration of onset of symptoms post COVID being 66 days. Conclusion Early diagnosis of post Covid 19 infection AVN hip can direct the management spectrum to its lower extremities and need of a case control study to confirm the causative effect Covid19 infection on avascular necrosis of hip were suggested.