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. 2023 Jul 11:29:e940965.
doi: 10.12659/MSM.940965.

Corticosteroid-Associated Avascular Necrosis of the Femoral Head in Patients with Severe COVID-19: A Single-Center Study

Vensan Velchov  1   2 , Pavel Georgiev  1   2 , Stefan Tserovski  1   2 , Tsvetan Tsenkov  1   2 , Venelin Alexiev  1   2
Affiliations

Corticosteroid-Associated Avascular Necrosis of the Femoral Head in Patients with Severe COVID-19: A Single-Center Study

Vensan Velchov et al. Med Sci Monit. .

Abstract

BACKGROUND Avascular necrosis (AVN) of the femoral head can result from high-dose corticosteroid therapy. Given that severe COVID-19 pneumonia patients respond positively to corticosteroids, this study aimed to explore the incidence of femoral head AVN associated with corticosteroid therapy in 24 patients diagnosed with severe COVID-19 at a single center. MATERIAL AND METHODS The study included 24 patients who were diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection through real-time reverse transcription polymerase chain reaction test (rRT-PCR) and with COVID-19 pneumonia via high-resolution computed tomography (HRCT). Moderate cases received 2×4 mg Dexamethasone while severe cases were also administered with 3×40 mg Methylprednisolone. Diagnosis of femoral head AVN was confirmed with magnetic resonance imaging (MRI) and radiographs, which was subsequently treated by a total hip arthroplasty (THA) or a core decompression surgery (CDS) in line with the Ficat and Arlet classifications RESULTS Among the patients, 8 had a moderate infection course, while 16 were severe. The mean corticosteroid duration was 15±5 days for Dexamethasone and 30 days for Methylprednisolone. Severe patients presented with higher grade femoral head AVN and greater pain levels compared to moderate cases (p<0.05). Four patients developed bilateral AVN. The treatment resulted in 23 THAs and 5 CDSs CONCLUSIONS The data from this study corroborate earlier studies and case reports, suggesting an increased occurrence of AVN of the femoral head during the COVID-19 pandemic due to the high-dose corticosteroid therapy employed for patients hospitalized with severe COVID-19 pneumonia.

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Conflict of interest statement

Conflict of interest: None declared

Figures

Figure 1
Figure 1
Axial HRCT images showing severe changes in COVID-19 pneumonia.
Figure 2
Figure 2
Sample anteroposterior (AP) and lateral radiographs (top), and MRI images (bottom) of femoral head AVN.
Figure 3
Figure 3
Patient eligibility assessment.
Figure 4
Figure 4
In the severe group, 88% presented with Grade 4 Ficat and Arlet femoral head lesions compared to 13% in the moderate group.
See this image and copyright information in PMC

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