Steroid Induced Avascular Necrosis of the Femoral Head after COVID-19 Disease and Treatment Options Including Free Vascularized Fibula Reconstruction

Abstract

The COVID-19 pandemic caused serious mortality and morbidity all over the world. SARS-CoV-2 infection can involve several different organ systems. Osteonecrosis has been reported in the femoral head of patients treated with corticosteroids due to COVID-19 similar to SARS-COV (severe acute respiratory syndrome) endemic in 2003. Being a tertiary hospital for osteonecrosis of femoral head (ONFH) for our country, we retrospectively analyzed OFNH patients for steroid administration for COVID-19 infection. Ten male and a female, mean age 38.7, total eleven patients (16 hips) who were treated with corticosteroids due to COVID-19 disease and had ONFH were found. Four of 11 patients were medical doctors. Cumulative dose of methylprednisolone in these patients was 1964.5 (+/-1083.2) mg. The mean daily dose of methylprednisolone was 289.4 (+/-182.6) mg. Free vascularized fibula reconstruction in 8 hips, core decompression in 3 hips and conservative treatment in 5 hips were done. Overall, visual analogue scale score for pain was decreased 2.9 points, Harris Hip score were increased 14.6 points and total hip range of motion were increased 45 degrees. The COVID-19 pandemic is an ongoing issue, and avascular necrosis of the femoral head should be considered in patients who present with hip pain at the late period after COVID-19.