Avascular Necrosis of the Hip Joint and Femoral Head Related with Long COVID-19 or Post-COVID-19: Case Report Study
DOI:
https://doi.org/10.3889/oamjms.2024.11889Keywords:
COVID-19, Long COVID, SARS Cov2, hip, femoral head osteonecrosis, avascular necrosis, hemostasis, coagulationAbstract
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.
Downloads
Metrics
Plum Analytics Artifact Widget Block
References
WHO coronavirus disease (COVID19) Dashboard. Available from: https://data.who.int/dashboards/covid19/cases?n=c [Last accessed on 2024 May 24].
Harapan H, Itoh N, Yufika A, Winardi W, Keam S, Te H, et al. Coronavirus disease 2019 (COVID-19): A literature review. J Infect Public Health. 2020;13(5):667-73. https://doi.org/10.1016/j.jiph.2020.03.019 PMid:32340833
Datta PK, Liu F, Fischer T, Rappaport J, Qin X. SARS-CoV-2 pandemic and research gaps: Understanding SARS-CoV-2 interaction with the ACE2 receptor and implications for therapy.
Theranostics. 2020;10(16):7448-64. https://doi.org/10.7150/thno.48076 PMid:32642005
Long COVID or post-COVID conditions. Centers for Disease Control and Prevention, US Department of Health and Human Services. 2022-12-16. Available from: https://www.cdc.gov/ coronavirus/2019-ncov/long-term-effects/index.html [Last accessed on 2023 Jan 08].
Mahase E. COVID19: What do we know about, “long covid”? BMJ. 2020;370:m2815. https://doi.org/10.1136/bmj.m2815 PMid:32665317
Li LQ, Huang T, Wang YQ, Wang ZP, Liang Y, Huang TB, et al. COVID-19 patients’ clinical characteristics, discharge rate, and fatality rate of meta-analysis. J Med Virol. 2020;92(6):577-83. https://doi.org/10.1002/jmv.25757 PMid:32162702
Leung TY, Chan AY, Chan EW, Chan VK, Chui CS, Cowling BJ, et al. Short- and potential long-term adverse health outcomes of COVID-19: A rapid review. Emerg Microbes Infect. 2020;9(1):2190-9. https://doi.org/10.1080/2 2221751.2020.1825914 PMid:32940572
Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708-20. https://doi.org/10.1056/NEJMoa2002032 PMid:32109013
Hong N, Du XK. Avascular necrosis of bone in severe acute respiratory syndrome. Clin Radiol. 2004;59(7):602-8. https://doi.org/10.1016/j.crad.2003.12.008 PMid:15208066
Daltro G, Silva IC, Daltro PB, Silva IC, Botelho VL. SARS- Cov2/COVID-19 and its implication in the development of Osteonecrosis. J Regen Biol Med. 2020;2(4):1-19. https//doi. org/10.37191/Mapsci-2582-385X-2(4)-035
Koutalos AA, Stefanou N, Malizos KN. Postacute sequelae of SARS-CoV-2 infection. Osteonecrosis must not be overlooked. Int J Infect Dis. 2022;121:11-3. https://doi.org/10.1016/j.ijid.2022.04.026 PMid:35462037
Jeyaraman M, Selvaraj P, Jeyaraman N, Gollahalli Shivashankar P, Muthu S. Assessment of risk factors in post- COVID-19 patients and its associated musculoskeletal manifestations: A cross-sectional study in India. J Orthop. 2022;33:131-6. https://doi.org/10.1016/j.jor.2022.07.011 PMid:35879984
Hoong CW, Amin MN, Tan TC, Lee JE. Viral arthralgia a new manifestation of COVID-19 infection? A cohort study of COVID-19-associated musculoskeletal symptoms. Int J Infect Dis. 2021;104:363-9. https://doi.org/10.1016/j.ijid.2021.01.031 PMid:33476761
Mukarram MS, Ishaq Ghauri M, Sethar S, Afsar N, Riaz A, Ishaq K. COVID-19: An emerging culprit of inflammatory arthritis. Case Rep Rheumatol. 2021;2021:6610340. https://doi.org/10.1155/2021/6610340 PMid:33986966
Yu EW, Tsourdi E, Clarke BL, Bauer DC, Drake MT. Osteoporosis management in the era of COVID-19. J Bone Miner Res. 2020;35(6):1009-13. https://doi.org/10.1002/jbmr.4049 PMid:32406536
Agarwala SR, Vijayvargiya M, Pandey P. Avascular necrosis as a part of “long COVID-19”. BMJ Case Rep. 2021;14(7):e242101. https://doi.org/10.1136/bcr-2021-242101 PMid:34215639
Malinowski K, Skowronek P, Hirschmann M, Kim DW, Henry BM, Ebisz M, et al. Transient spontaneous osteonecrosis of the knee (SONK) shortly after SARS-CoV-2 infection: A report of 2 cases. Adv Clin Exp Med. 2022;31(9):1035-41. https://doi.org/10.17219/acem/153004 PMid:36135812
Metha P, McAuley DF, Brown M, Saqnchez E, Tattersall RS, Manson JJ, et al. COVID- 19: Consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395(10229):1033-4. https://doi.org/10.1016/S0140-6736(20)30628-0 PMid:32192578
Powell C, Chang C, Naguwa SM, Cheema G, Gershwin ME. Steroid induced osteonecrosis: An analysis of steroid dosing risk. Autoimmun Rev. 2010;9(11):721-43. https://doi.org/10.1016/j.autrev.2010.06.007 PMid:20621176
Chan KL, Mok C. Glucocorticoid-induced avascular bone necrosis: Diagnosis and management. Open Orthop J. 2012;6:449-57. https://doi.org/10.2174/1874325001206010449 PMid:23115605
Assouline-Dayan Y, Chang C, Greenspan A, Shoenfeld Y, Gershwin ME. Pathogenesis and natural history of osteonecrosis. Semin Arthritis Rheum. 2002;32(2):94-124. PMid:12430099
McKee MD, Waddell JP, Kudo PA, Schemitsch EH, Richards RR. Osteonecrosis of the femoral head in men following short- course corticosteroid therapy: A report of 15 cases. CMAJ. 2001;164(2):205-6. PMid:11332313
Agarwala S, Shah S, Joshi VR. The use of alendronate in the treatment of avascular necrosis of the femoral head: Follow-up to eight years. J Bone Joint Surg Br. 2009;91(8):1013-8. https://doi.org/10.1302/0301-620X.91B8.21518 PMid:19651826
Lafforgue P. Ostéonécrose aseptique de la tête fémorale [Osteonecrosis of the femoral head]. Rev Prat. 2006;56(8):817-25. PMid:16764239
Agarwala SR, Vijayvargiya M, Sawant T. Secondary osteonecrosis of the knee as a part of long COVID-19 syndrome: A case series. BMJ Case Rep. 2022;15(3):e248583. https://doi.org/10.1136/bcr-2021-248583 PMid:35351759
Angulo-Ardoy M, Ureña-Aguilera Á. Knee osteonecrosis after COVID-19. Fam Pract. 2021;38(Suppl 1):i45-7. https://doi.org/10.1093/fampra/cmab063 PMid:34448481
Mañón VA, Balandran S, Young S, Wong M, Melville JC. COVID- associated avascular necrosis of the maxilla-a rare, new side effect of COVID-19. J Oral Maxillofac Surg. 2022;80(7):1254-9. https://doi.org/10.1016/j.joms.2022.04.015 PMid:35588767
Zhao FC, Guo KJ, Li ZR. Osteonecrosis of the femoral head in SARS patients: Seven years later. Eur J Orthop Surg Traumatol. 2013;23(6):671-7. https://doi.org/10.1007/s00590-012-1054-4 PMid:23412187
Guo KJ, Zhao FC, Guo Y, Li FL, Zhu L, Zheng W. The influence of age, gender and treatment with steroids on the incidence of osteonecrosisofthefemoralheadduringthemanagementofsevere acute respiratory syndrome. Bone Joint J. 2014;96-B(2):259-62. https://doi.org/10.1302/0301-620X.96B2.31935 PMid:24493194
Parasher A. COVID-19: Current understanding of its pathophysiology, clinical presentation and Treatment. Postgrad
Med J. 2021;97(1147):312-20. https://doi.org/10.1136/postgradmedj-2020-138577 PMid:32978337
Available from: https://www.covid19treatmentguidelines.nih.gov [Last accessed on 2024 Feb 14].
Bahsoun A, Fakih Y, Zareef R, Bitar F, Arabi M. Corticosteroids in COVID-19: Pros and cons. Front Med (Lausanne). 2023;10:1202504. https://doi.org/10.3389/fmed.2023.1202504 PMid:37644981
Coutinho AE, Chapman KE. The anti-inflammatory and immunosuppressive effects of glucocorticoids, recent developments and mechanistic insights. Mol Cell Endocrinol. 2011;335(1):2-13. https://doi.org/10.1016/j.mce.2010.04.005 PMid:20398732
Tamez-Pérez HE, Quintanilla-Flores DL, Rodríguez- Gutiérrez R, González-González JG, Tamez-Peña AL. Steroid hyperglycemia: Prevalence, early detection and therapeutic recommendations: A narrative review. World J Diabetes. 2015;6(8):1073-81. https://doi.org/10.4239/wjd.v6.i8.1073 PMid:26240704
Ericson-Neilsen W, Kaye AD. Steroids: Pharmacology, complications, and practice delivery issues. Ochsner J. 2014;14(2):203-7. PMid:24940130
Wilson AJ, Murphy WA, Hardy DC, Totty WG. Transient osteoporosis: Transient bone marrow edema? Radiology. 1988;167(3):757-60. https://doi.org/10.1148/radiology.167.3.3363136 PMid:3363136
Hauzeur JP, Malaise M, Gangji V. Osteonecrosis in inflammatory bowel diseases: A review of the literature. Acta Gastroenterol Belg. 2009;72(3):327-34. PMid:19902866
Mirzai R, Chang C, Greenspan A, Gershwin ME. The pathogenesis of osteonecrosis and the relationships to corticosteroids. J Asthma. 1999;36(1):77-95. https://doi.org/10.3109/02770909909065152
Di Minno MN, Calcaterra I, Lupoli R, Storino A, Spedicato GA, Maniscalco M, et al. Hemostatic changes in patients with COVID-19: A meta-analysis with meta-regressions. J Clin Med. 2020;9(7):2244. https://doi.org/10.3390/jcm9072244 PMid:32679766
Williams JO, Nash J, Whelan C, Raven BM, Davies AJ, Evans J, et al. Early but reversible haemostatic changes in a-symptomatic females expressing COVID-19 antibodies. Thromb Res. 2022;217:76-85. https://doi.org/10.1016/j.thromres.2022.07.012 PMid:35908384
Jovanoski M, Boshev M, Marinkovikj Petrusevska S, Srceva Jovanovski M, Georgiev A, Damjanovska LJ. Pulmonary embolism in a patient with COVID-19 pneumonia despite satisfying anticoagulation status. Maced J Anaesth. 2022;3(6):60-9.
Jawad MU, Haleem AA, Scully SP. In brief: Ficat classification: Avascular necrosis of the femoral head. Clin Orthop Relat Res. 2012;470(9):2636-9. https://doi.org/10.1007/s11999-012-2416-2 PMid:22760600
Shetty GM. Double trouble-COVID-19 and the widespread use of corticosteroids: Are we staring at an osteonecrosis epidemic? Indian J Orthop. 2021;56(2):226-36. https://doi.org/10.1007/s43465-021-00546-8 PMid:34720174
Babhulkar S. Osteonecrosis of femoral head: Treatment by core decompression and vascular pedicle grafting. Indian J Orthop.2009;43(1):27-35.https://doi.org/10.4103/0019-5413.45320 PMid:19753176
Velkovski V, Shabani I, Kamnar V, Gavrilovski A, Todorova T, Doksevska-Bogojevska M, et al. Analysis of results after surgical application of bone marrow aspirate stem cell concentrate in the treatment of avascular necrosis of the femoral head. Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2023;44(1):79-87. https://doi.org/10.2478/prilozi-2023-0009 PMid:36987770
Downloads
Additional Files
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2024 Sanja Petrusevska-Marinkovic, Milena Doksevska-Bogojevska, Mario Jovanovski, Tanja Savin, Bojana Novachkova-Siljanovska (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0)
