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Osteonecrosis with Concomitant Bacterial Osteomyelitis of Both Hips and a Knee in a Post-COVID-19 Patient: A Case
Sanjeev Jain1,2, Tushar Sawant3
1Orthopaedic and Joint Replacement Surgeon, Department of Orthopaedics, Dr L H Hiranandani Hospital, Powai, Mumbai, Maharashtra, India.
Insights
This case study details a COVID-19 survivor who developed osteonecrosis and bacterial osteomyelitis in his hips and knee. Successful surgical intervention led to a full recovery with no signs of active infection.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Rheumatology
Background:
- Osteonecrosis is a known complication of severe COVID-19 and corticosteroid treatment.
- Acute bacterial osteomyelitis is a serious bone infection.
Observation:
- A 42-year-old male, recovered from COVID-19, presented with osteonecrosis and acute bacterial osteomyelitis affecting both hips and the left knee.
- The patient underwent total hip replacement for bilateral hip osteonecrosis and arthroscopic procedures for the knee joint infection.
Findings:
- Surgical management resulted in complete and painless range of motion for the patient.
- Post-operative follow-up showed resolving osteomyelitis with no evidence of active infection.
Implications:
- Concomitant bacterial osteomyelitis in COVID-19-associated osteonecrosis is rare and can be challenging to diagnose due to elevated inflammatory markers.
- Early recognition and appropriate surgical and antimicrobial treatment are crucial for favorable outcomes in such complex cases.
Case:
We report the case of a coronavirus disease 2019 (COVID-19)-recovered, 42-year-old man with osteonecrosis and concomitant acute bacterial osteomyelitis of both hips and his left knee. The patient underwent total hip replacement for both hips and arthroscopic decompression and synovectomy of the knee joint. On follow-up, he has complete and painless range of motion with resolving osteomyelitis and no signs of active infection.
Conclusion:
Corticosteroid therapy and COVID-19-associated thrombotic microangiopathy might have caused osteonecrosis in our patient. However, concomitant osteomyelitis is extremely rare and might be overlooked because of elevated inflammatory markers after recovery from COVID-19 infection.
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