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Post-COVID-19 Steroid-Induced Avascular Necrosis of the Hip: Does Severity of Infection Influence Functional Outcome?

Mobinul Hoque1, Mohammad Lockman1, Mohammad Kamruzzaman2

  • 1Orthopaedic Surgery, National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, BGD.

Cureus
|August 22, 2025
PubMed

Insights

Patients with moderate COVID-19 and steroid-induced avascular necrosis (AVN) showed better outcomes after total hip replacement (THR). Infection severity and steroid dose may impact recovery following this procedure.

Area of Science:

  • Orthopedics
  • Infectious Diseases
  • Pharmacology

Background:

  • Corticosteroids are used for moderate to severe COVID-19.
  • Steroid use is linked to avascular necrosis (AVN) of the femoral head.
  • This study investigates post-COVID-19 steroid-induced AVN requiring total hip replacement (THR).

Purpose of the Study:

  • To evaluate the association between COVID-19 severity and functional outcomes in patients undergoing THR for steroid-induced AVN.
  • To assess the impact of steroid burden and infection severity on hip function after THR.

Main Methods:

  • Prospective observational study of 26 patients with steroid-induced AVN post-COVID-19.
  • All patients underwent cementless THR.
  • COVID-19 severity, steroid exposure, and hip function (modified Harris hip score) were assessed pre- and post-operatively at 12 months.

Main Results:

  • Severe COVID-19 patients had higher steroid doses and longer exposure than moderate cases.
  • Both groups improved significantly in hip function (MHHS) post-THR.
  • Moderate COVID-19 patients achieved slightly higher MHHS scores (89.2 vs. 85.8).

Conclusions:

  • Total hip replacement (THR) yields satisfactory outcomes for post-COVID-19 steroid-induced AVN.
  • Moderate COVID-19 infection may correlate with marginally better functional recovery after THR.
  • Infection severity and steroid burden might influence postoperative prognosis in these patients.
Abstract

Keywords:
avascular necrosiscorticosteroidcovid-19functional outcomemodified harris hip scoretotal hip replacement

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