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Outcomes of Hip Avascular Necrosis Following COVID-19 Infection: A Retrospective Analysis of 212 Hips With Minimum
Adarsh Annapareddy1, Praharsha Mulpur1, Tarun Jayakumar1
1Orthopaedics, Sunshine Bone and Joint Institute, KIMS-Sunshine Hospitals, Hyderabad, IND.
Introduction:
Avascular necrosis (AVN) of the femoral head has been observed to occur after COVID-19, especially if steroids were taken. However, the knowledge about its progress in these cases is lacking. We aimed to evaluate the progress of a disease after post-COVID AVN and the effect of various treatments.
Methods:
This was a retrospective observational study conducted on 118 patients (212 hips) diagnosed with hip AVN following COVID-19 infection between June 2021 and September 2021. Patients were followed up for a minimum duration of 2 years and evaluated based on demographics, Ficat and Arlet staging, corticosteroid usage, and assessment of treatment modality outcomes. Harris Hip Scores (HHS) were recorded at presentation, 3 months, and 2 years.
Results:
The mean age of the cohort was 36.8 years (SD: 10.9), with a majority of males (N=103, 87.3%). The mean interval between the diagnosis of COVID-19 and the onset of hip symptoms was 10.8 months (range: 1-24 months; SD: 5.9) and the mean interval between the onset of hip symptoms and the diagnosis of AVN was 3.65 weeks (range: 1-8 weeks; SD: 1.9), indicating the rapid progress of the disease. The majority of them presented with bilateral AVN (79.7%), with Ficat and Arlet Grade 2 (50.9%) and Grade 3 (41%) AVN, respectively. The mean cumulative steroid dose (prednisolone equivalents) was 439.27 mg (SD: 583.29), with a mean duration of 12.76 days (SD: 12.3). Patients managed conservatively showed an initial improvement in HHS from 77.3 (SD: 11) at presentation to 88.4 (SD: 7.6) at 3 months but declined to 81.8 (SD: 9.7) at 2 years (p<0.001). Core decompression alone resulted in a decline from 73 (SD: 13.5) to 69.5 (SD: 12) at 2 years. In contrast, total hip arthroplasty (THA) led to significant improvement from 64.4 (SD: 12.4) to 92.4 (SD: 3.3) at 2 years (p<0.001).
Conclusion:
Post-COVID-19 AVN is an aggressive and rapidly progressing condition affecting young individuals, even with relatively low corticosteroid exposure. Conservative treatments provide only transient benefit, while THA offers substantial and sustained functional improvement in advanced AVN. Early identification and timely surgical intervention, where indicated, are crucial to optimizing patient outcomes in clinical practice.
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