Orthopaedic and Traumatology Department, Assiut University Hospital, Assiut, Egypt.
Orthopedic Department, Qena Faculty of Medicine, South Valley University, Kilo 6 Qena-Safaga Highway, Qena, Egypt.
Rheumatol Int. 2023 Sep;43(9):1583-1595. doi: 10.1007/s00296-023-05373-8. Epub 2023 Jun 20.
The current systematic review aimed to document published cases of femoral head avascular necrosis (FHAVN) post-COVID-19, to report the COVID-19 disease characteristics and management patients received, and to evaluate how the FHAVN were diagnosed and treated among various reports. A systematic literature review was performed per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines through a comprehensive English literature search on January 2023 through four databases (Embase, PubMed, Cochrane Library, and Scopus), including studies reporting on FHAVN post-COVID-19. Fourteen articles were included, ten (71.4%) were case reports, and four (28.6%) case series reported on 104 patients having a mean age of 42.2 ± 11.7 (14:74) years, in which 182 hip joints were affected. In 13 reports, corticosteroids were used during the COVID-19 management plan for a mean of 24.8 ± 11 (7:42) days, with a mean prednisolone equivalent dose of 1238.5 ± 492.8 (100:3520) mg. A mean of 142.1 ± 107.6 (7:459) days passed between COVID-19 diagnosis and FHAVN detection, and most of the hips were stage II (70.1%), and concomitant septic arthritis was present in eight (4.4%) hips. Most hips (147, 80.8%) were treated non-surgically, of which 143 (78.6%) hips received medical treatment, while 35 (19.2%) hips were surgically managed, 16 (8.8%) core decompression, 13 (7.1%) primary THA, five (2.7%) staged THA and three (1.6%) had first stage THA (debridement and application of antibiotic-loaded cement spacer). The outcomes were acceptable as regards hip function and pain relief. Femoral head avascular necrosis post-COVID-19 infection is a real concern, primarily attributed to corticosteroid usage, besides other factors. Early suspicion and detection are mandatory, as conservative management lines are effective during early stages with acceptable outcomes. However, surgical intervention was required for progressive collapse or patients presented in the late stage.
本次系统综述旨在记录新冠病毒感染后患股骨头缺血性坏死（FHAVN）的病例，报告患者接受的新冠病毒疾病特征和管理，并评估在各种报告中如何诊断和治疗 FHAVN。按照系统评价和荟萃分析的首选报告项目（PRISMA）指南，通过 2023 年 1 月对四个数据库（Embase、PubMed、Cochrane 图书馆和 Scopus）进行的全面英文文献检索，开展了一项系统文献综述，包括报告新冠病毒感染后患 FHAVN 的研究。共纳入 14 篇文章，其中 10 篇（71.4%）为病例报告，4 篇（28.6%）为病例系列报告，共纳入 104 例患者，平均年龄为 42.2±11.7（14：74）岁，共累及 182 个髋关节。在 13 份报告中，新冠病毒管理方案中使用了皮质类固醇，平均使用时间为 24.8±11（7：42）天，平均泼尼松等效剂量为 1238.5±492.8（100：3520）mg。从新冠病毒诊断到 FHAVN 检测的平均时间为 142.1±107.6（7：459）天，大多数髋关节处于 II 期（70.1%），8 个髋关节（4.4%）合并感染性关节炎。大多数髋关节（147，80.8%）采用非手术治疗，其中 143 个（78.6%）髋关节接受药物治疗，35 个（19.2%）髋关节手术治疗，16 个（8.8%）采用核心减压术，13 个（7.1%）行初次全髋关节置换术，5 个（2.7%）分期全髋关节置换术，3 个（1.6%）行初次全髋关节置换术（清创和应用抗生素载骨水泥间隔器）。髋关节功能和疼痛缓解方面的结果是可接受的。新冠病毒感染后患股骨头缺血性坏死是一个现实问题，主要与皮质类固醇的使用有关，此外还有其他因素。早期怀疑和检测是必要的，因为早期的保守治疗方案是有效的，且结果可接受。然而，对于进展性塌陷或晚期出现的患者，则需要手术干预。
