Vascular necrosis (AVN) is the death of bone tissue due to lack of blood supply. Also known as osteochondrosis, it can lead to small fractures in the bone, leading to the final collapse of the bone. A broken bone or dislocated joint can block blood flow to a section of bone. As a result, it can no longer easily rotate inside the socket, which damages the joint and results in joint arthritis. Vascular necrosis is also associated with long-term use of high-dose steroid drugs and excessive alcohol consumption. Although it can affect almost anyone, it is most common in people between the ages of 30 and 50.
One of the most common risk factors for AVN / Osteonecrosis is overuse of steroid drugs, as mentioned earlier. Although osteochondrosis of the hip joint is not a new condition, it has recently been observed in the treatment of patients with COVID19 with increased frequency due to extensive steroid use. It is one of the most crippling manifestations of post-COVID19 syndrome. Steroids play an important role in the treatment of severe COVID19 cases and often save patients’ lives, so they should be used judiciously to reduce the risk of bone loss. Steroids should be used in the shortest possible amount for a short period of time and are only prescribed.
Although it is clear that vascular necrosis (AVN) or osteochondrosis is caused directly by high-dose steroid therapy, case reports show that the rapid onset of recovery from AVN after COVID19 infection is not due solely to steroid therapy and is motivated by other risks. Infection is in the game. It is therefore important for treating physicians to consider this post-recovery adverse effect and ensure that prophylactic bisphosphonate therapy (bisphosphonates are a group of drugs that slows or prevents bone loss, strengthens bones) is started at the right time. is coming. Synchronous way. It has been suggested that simultaneous doses of bisphosphonate group drugs (especially Ibandronate 2mg) every three months help prevent steroidal induced side effects to be effective and well tolerated.
Patients with osteochondrosis of the hip joint also show symptoms of pain in the groin, buttocks, or upper thighs. Other signs of the disease include numbness, inability to lift weights on the affected leg, and lameness. Some patients usually show these symptoms 6-9 months after COVID19 infection and have a history of steroid use. In about 30-40% of cases, the problem is bilateral, where both hip joints are affected. In such cases, early diagnosis is crucial in the treatment of this condition. In the early stages, vascular necrosis (AVN) can be successfully managed with medical treatment or minor invasive surgeries, which help maintain the patient’s natural hip joint. However, in advanced cases where the ball of the hip joint is broken or the hip joint is damaged, total hip replacement is the only practical solution.
Take, for example, our recent case, where a 49-year-old male patient suffered from COVID19 infection more than a year ago; As part of his treatment, he received steroids. She started complaining of pain in her right hip and difficulty walking about four months ago. Given his history of Covid 19 infections and steroid treatment, an MRI of the hip joint was ordered immediately. He confirmed the diagnosis of AVN which was in advanced stage with the fall of the ball. The patient successfully underwent total hip replacement (THR) with us six weeks ago. The patient is now pain free and able to walk normally.
It is imperative that all patients with a history of Covid 19 infection and steroid use be cautious and that if they experience pain or any other symptoms, seek medical attention immediately, as mentioned earlier. It should also be noted that in the early stages, X-rays are standard, and MRI is required to establish a diagnosis of hip osteochondrosis. A lower threshold for obtaining an MRI will ensure an early diagnosis, which can help start timely treatment that can prevent or delay hip joint damage.
(Inputs from Dr. Siddharth M. Shah, Consultant-Orthopedics and Joint Replacement Surgeon, SL Raheja Hospital, Mahim and Dr. Manish Sontakke, Consultant-Orthopedic Surgery, Hiranandani Hospital, Vashi-A Fortis Network Hospital)
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