Avascular Necrosis (AVN) post-COVID

by | Jun 15, 2022 | Failed/ Revision

The SAR-CoV-2-related illness, known as the COVID-19 infection, has had a major impact on the large number of people globally. Increasing death rates have been estimated due to the COVID-19 infection. Even though several COVID-19 patients are recovering from the infection, there are still increasing issues apart from the lungs after recovery from the seemingly severe illness. One of the most serious consequences is ‘Avascular Necrosis’ (AVN). It is death of the bone tissue due to a lack of blood supply to a small part, causing small breakages within the bones, that eventually results in collapse of the bone. This usually happens in the ball of the hip joint. As this is a large weight bearing joint, bone collapse results in friction during movement, damage to the joint and joint arthritis.

AVN is concerned with the use of high-dose steroid medication that might have been given to many patients treated in ICU. Steroids are essential in treating severe COVID-19 cases and effective in saving patients’ lives. However, specialists would use them judiciously and for a short- term. Alternative medicine therapies containing plant extracts could contain steroids too, especially when these extracts are not chemically tested. Long term use might give the patient a feel- good experience, as happens in many unwarranted over the counter alternative therapies advertised for various ailments, but causes weight gain. AVN was earlier known as a disease entity following excess alcohol consumption for a long period of time, as also for other rare causes. Although it is clear that high-dose steroid therapy directly contributes to AVN, several case reports have suggested that other hazards brought on by the infection may also contribute (impact of cell reaction from the virus directly), resulting in the quick onset of AVN following the recovery from COVID-19 infection.

AVN affects people at any age group, but common around 30–50 years. Many patients who have recovered from COVID-19 infection have complained about hip pain, which is now a growing concern with long- term devastating complications post COVID. The symptoms are often 6- 9 months after recovery from the chest related illness. AVN leads to symptoms of pain in the hip joint, buttocks, and upper thigh region. Other symptoms include stiffness, inability to take up weight on the affected leg, and limping. Almost 30%–40% of patients have bilateral issues in which the patients suffer from pain in both of their hip joints. Hence, early diagnosis in such conditions is considered important for treatment.

Avascular Necrosis (AVN) can be managed successfully in the initial phase with the integration of medical treatment or by patients undergoing minor invasive surgeries that help them preserve their natural hip joint. It is considered important for physicians to spread awareness of the post-recovery adverse effects. All individuals with a history of COVID-19 infection and use of steroids should undergo regular check-ups and seek specialist assistance immediately in case they experience any of the previously described symptoms, including pain. In the initial phase, X-rays are used as the standard diagnostic approach, and MRI is important for the diagnosis of AVN in cases of pain in the hip joints. A low threshold in MRI will ensure early diagnosis, which suggests the integration of immediate therapy and provides assistance by stopping and delaying the damage to the bones and joints.

Bisphosphonates are a group of medicines that work to strengthen the bone and slow down or stop bone degeneration. In detected cases (diagnosed by MRI in early stages), it is possible to inject the Bisphosphonate drug into the bone as a day- care procedure and prevent further damage. In slightly advanced cases, regeneration of bone can be aided with surgical procedure involving use of Bone Marrow derived Stem Cells. It was earlier a notion that AVN will eventually lead to Total Hip Replacement surgery. However, early detection can help prevent the major surgery involving metal implants altogether. In some advanced cases where the ball of the hip joint is dislocated, collapsed or damaged, then this surgery is inevitable. However when undertaken in a modern specialist unit, there are very good technical developments in this operation that can provide a normal quality of life with metal prosthesis survival longer than 4-5 decades, thereby restoring life and productivity for younger affected individuals.