Avascular Necrosis of the Hip Joint and Femoral Head Related with Long COVID-19 or Post-COVID-19: Case Report Study

Sanja Petrusevska-Marinkovic; Milena Doksevska-Bogojevska; Mario Jovanovski; Tanja Savin; Bojana Novachkova-Siljanovska

doi:10.3889/oamjms.2024.11889

Authors

Sanja Petrusevska-Marinkovic University Clinic for Respiratory Diseases in Children “Kozle”- Skopje, Republic of North Macedonia; Department of Infectious Diseases, Medical Faculty, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of North Macedonia https://orcid.org/0009-0009-3224-2016
Milena Doksevska-Bogojevska University Clinic for Orthopaedic Surgery, Skopje, Republic of North Macedonia https://orcid.org/0000-0003-0885-0491
Mario Jovanovski University Clinic for Cardiology, Skopje, Republic of North Macedonia https://orcid.org/0009-0000-2804-7124
Tanja Savin University Clinic for Respiratory Diseases in Children “Kozle”- Skopje, Republic of North Macedonia https://orcid.org/0009-0006-1469-3380
Bojana Novachkova-Siljanovska University Clinic for Respiratory Diseases in Children “Kozle”- Skopje, Republic of North Macedonia https://orcid.org/0009-0003-8078-0675

DOI:

https://doi.org/10.3889/oamjms.2024.11889

Keywords:

COVID-19, Long COVID, SARS Cov2, hip, femoral head osteonecrosis, avascular necrosis, hemostasis, coagulation

Abstract

BACKGROUND: Post-COVID conditions can include a wide range of ongoing health problems. As a consequence of long COVID-19 or post-COVID-19 an increase in osteonecrosis has been detected in different series of patients.

CASE PRESENTATION: We present two patients diagnosed with COVID-19 and pneumonia, one with moderate and the other with severe clinical picture. They were treated with corticosteroid equivalent to prednisolone 993.5 mg (400–1587 mg) which correlates with steroid dose documented in the literature as causative for avascular necrosis (ANV) in patients with COVID-19. After the mean time of 65 days, due to pain in the groin and difficulty in movement, magnetic resonance imaging (MRI) was performed in both patients and AVN was diagnosed. Compared to our results, the literature records a longer time required for the development of AVN in patients without COVID-19, which is 6–36 months. This indicates the potency of the virus itself to cause disturbances in the microcirculation, and thus the development of AVN. The bone damage correlates with the degree of inflammation and the severity of the clinical picture.

CONCLUSION: After a course of COVID-19 as part of a long COVID-19, ANV should be considered a possible complication, especially in patients who have clinical manifestations. Early detection of AVN and diagnosis using MRI on clinical suspicion would help early intervention with bisphosphonate therapy in patients with osteonecrosis of the hip. If the disease is detected in the more advanced stage, it is necessary to perform a surgical intervention and even a possible hip replacement.

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