Is there an Increase in Total Hip Arthroplasty Due to Osteonecrosis of Femoral Head After Covid-19 Pandemic?: A Retrospective Study Among Patients in Central Karnataka, India

Abstract

Introduction: Coronavirus disease 2019 (COVID-19) infection or corticosteroid usage during the COVID-19 pandemic as risk factors for avascular necrosis (AVN) of the femoral head (osteonecrosis of the femoral head/femoral head AVN [FHAVN]), as well as its link to clinical and radiological outcomes, are poorly understood. Osteonecrosis, which results from a disruption in vascular supply to the femoral head, is a prevalent cause of hip joint deterioration and one of the most common reasons for total hip arthroplasty (THA)/total hip replacement in India and other Asian countries. This study will aid in understanding the condition's epidemiology and statistically determining the risk of disease related with pandemic exposure.

Materials and methods: This is a retrospective study of 100 hips diagnosed with osteonecrosis/osteoarthritis of the femoral head that underwent THA at a tertiary care center before and after the COVID-19 pandemic between February 2014 and February 2024.

Results: Late stages of FHAVN, when the diagnosis requiring THA, following the pandemic have increased exponentially. It has also switched from affecting the middle-aged to the younger age groups. Furthermore, the bilaterality necessitating THA has increased considerably. There is a clear shift in the presentation of this disabling illness, as well as the need for THA, which otherwise is rarely carried out on younger people. Furthermore, data on how much corticosteroids were used in the treatment is disturbingly scant, and how it may have contributed to this ailment in India is still questionable.

Conclusion: The COVID-19 pandemic could be the most serious threat, causing late-stages FHAVN (stages 3 and 4 of the Ficat and Arlet classification), in an accelerated manner, necessitating THA and overburdening existing medical care.

Keywords: Asia; COVID-19; India; femoral head; osteonecrosis; osteonecrosis of the femoral head/femoral head avascular necrosis; pandemic; total hip replacement/total hip arthroplasty.

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Graphical representation of Table 1.

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Graphical representation of Table 2.

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Graphical representation of Table 4.

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Graphical representation of Table 5.

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Post-pandemic femoral head avascular necrosis total hip replacement patients’ data with respect to coronavirus disease 2019 infection and the treatment modality.

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A 21-year-old young adult with left grade 4 Ficat and Arlet femoral head avascular necrosis post-coronavirus disease 2019 infection who underwent total hip arthroplasty in 2021.

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A 22-year-old female who underwent total hip arthroplasty on left side in 2021 and other hip in 2022 but was never diagnosed with coronavirus disease 2019 infection.

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A 40-year-old male diagnosed with left side Grade 4 femoral head avascular necrosis (AVN) and right side Grade 2 AVN who underwent total hip arthroplasty, with a history of coronavirus disease 2019 infection and hospitalization in intensive care unit for 1 week.