In addition to issues like mucormycosis, blood clots, chronic fatigue, and new-onset diabetes, people who received steroid treatment for COVID-19 are getting detected with the complication of Avascular Necrosis (AVN), commonly known as bone death. Steroid usage to improve lung function in coronavirus patients led to AVN.
Avascular necrosis or bone tissue death is caused by the lack of blood supply. It mainly impacts the head of femur (thigh bone) and can result in significant damage to a critical weight-bearing joint (hip joint).
Dr Gadekar added, “Patients may experience pain in the hip or groin area , sometimes in knee and often find it challenging to walk or start limping as a result of the disease. Sitting cross legged and squatting is difficult. In the early stages, such as grade I or II, medication and additional therapy can effectively manage the condition. For grades I and II, core decompression is performed through surgical drilling of femur head to alleviate pressure, improve blood circulation, and prevent further damage to the bone or joint. In addition to core decompression use of other adjuvants such as PRP, BMAC and stem cells is useful. Failure in treating AVN can lead to complete collapse of the femur head necessitating surgery (Total Hip Replacement - THR).”
There are many causes of AVN. Before COVID 50% cases of AVN were categorised as idiopathic (where exact cause is not known). In remaining 50% cases causes were excess steroid use, alcohol intake, sickle cell disease, fracture or dislocation of hip joints, coagulation disorders.
Dr Srisanat Rao, Joint Replacement Surgeon, Zynova Shalby Hospital said, Avascular necrosis has emerged as a concerning complication in post-Covid patients. The virus itself causes excessive inflammation throughout the body, which can disrupt blood flow to various organs and tissues. Additionally, overuse of steroids in a majority of patients has also led to the onset of this painful condition which limits one from doing his/her daily activities with ease. On an average I have witnessed around 3-4 cases on a monthly basis with an equal distribution between males and females. Most are in the middle age group although any age group can be involved. Understanding and addressing this surge requires comprehensive planning to help the patients manage this condition medically. Also, sometimes, it is suggested to do Total Hip Replacement to patients based on the severity of the condition, especially in the late stages of this disease.
Consequently, there has been a notable increase in cases of avascular necrosis of the hip during the post-Covid era. The occurrence of avascular necrosis is attributed to both steroid usage in Covid treatment and the virus itself. The Covid virus induces coagulopathies (excessive blood clotting), leading to circulation blockages. Each month, several patients seek treatment in the outpatient department for avascular necrosis. Prior to the Covid pandemic, around 1-2 cases were seen per month,” said Dr Anup Gadekar, Orthopedic Surgeon, Apollo Spectra Pune.
Dr Ashish Arbat, Joint Replacement and Orthopedic Surgeon, Jahagir Hospital said, 2 to 3 AVN patients come for treatment every week. The case of AVN was seen after the second wave of Corona. The main reason behind that is that many people started feeling this problem due to excessive use of Steroids for Corona treatment. However, patients coming for treatment now do not suffer from these problems due to steroids. There are many reasons behind this. In addition, AVN is not easily diagnosed. It takes seven to eight months.
Dr Amol Patwari, Orthopedic surgeon at Pune Said, Currently 8 to 10 AVN patients are coming to the hospital for treatment every month. AVN problem has been observed in many people due to steroid drugs given to patients to speed up their recovery during Corona. About 30 percent of AVN cases are due to steroid medications. In addition, avascular necrosis (AVN) is idiopathic in about 70% of cases. Because we ask patients who come to us if they have ever taken steroids. But, not all these patients have taken steroid medicine. So genetic diseases or other factors are also responsible for the problem of AVN.
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