# The association of COVID-19 with the development of acute avascular necrosis of the head of the femur, apart from steroid usage

## TL;DR

This study finds a link between COVID-19 and avascular necrosis of the femur, especially in patients who used steroids.

## Contribution

The study identifies a significant association between post-COVID-19 status and avascular necrosis, independent of steroid use.

## Key findings

- 25.6% of patients with avascular necrosis had a history of COVID-19.
- Steroid use was strongly associated with avascular necrosis (odds ratio of 4.47).
- AVN was more common in younger males and those with comorbidities.

## Abstract

Background: The SARS-CoV-2 pandemic (COVID-19) has significantly impacted global health, with emerging evidence indicating potential long-term complications affecting various organ systems, including the musculoskeletal system, like avascular necrosis (AVN) of the femoral head. This retrospective study aims to investigate the incidence and risk factors of AVN in patients treated for COVID-19.

Methods: We conducted a cross-sectional retrospective study in the department of orthopedics at a tertiary care teaching hospital in Central India from July 2022 to December 2023. Patients presenting with new-onset hip pain and low back pain who were asymptomatic before COVID-19 with a new radiological diagnosis of AVN hip were included in the study. Data on demographics, comorbidities, steroid use, and COVID-19 management were collected and analyzed using statistical tests to identify associations between these factors and AVN incidence.

Results: A total of 86 patients met the inclusion criteria. The majority of participants were males (83.7%), predominantly within the 30–45 years (44.2%) and 15–30 years (30.2%) age groups. Bilateral AVN was observed in 62.8% of cases. A significant portion (25.6%) had a history of COVID-19, with steroid use prevalent among 30.2% of participants, with an odds ratio of 4.47 indicating strong association. Statistically significant associations were found between COVID-19 status and age distribution (p = 0.049), comorbidities (p = 0.014), symptom onset (p = 0.001), and steroid therapy history (p = 0.002).

Conclusions: This study highlights a notable incidence of AVN among COVID-19 patients, with significant correlations to steroid use and specific comorbidities. The findings underscore the importance of vigilant monitoring for AVN in post-COVID-19 patients, particularly those with a history of steroid therapy. Further research is needed to elucidate the mechanisms linking COVID-19 and AVN and to develop targeted prevention strategies.