Seong Jichang, Babakulov Abduaziz, Asilova Saodat, Shakhnoza Babamukhamedova, Nodira Makhmudova, Mirzayev Akbarjon
School of Medicine, Central Asian University, Tashkent, 111221, Uzbekistan.
Department of Orthopedics and Traumatology, Akfa Medline University Hospital, Tashkent, 100211, Uzbekistan.
J Orthop Surg Res. 2025 Apr 10;20(1):362. doi: 10.1186/s13018-025-05657-8.
The COVID-19 pandemic has claimed many lives and continues to impact individuals through post-COVID-19 conditions. Osteonecrosis of the femoral head (ONFH) is increasingly recognized as a major post-COVID-19 complication, yet most studies are limited to case reports and small series. This study aimed to evaluate COVID-19-related factors potentially contributing to ONFH development in post-COVID-19 patients.
A retrospective analysis was conducted on 84 patients with ONFH and a confirmed history of COVID-19. Baseline characteristics were collected, and patients were categorized into the following groups for comparative analysis: (1) vaccinated vs. unvaccinated, (2) unilateral vs. bilateral ONFH, (3) dexamethasone (DEX) and methylprednisolone (MPS) vs. DEX therapy, and (4) Association Research Circulation Osseus (ARCO) stage 2 vs. stage 3. Group differences and associations were analyzed.
The DEX and MPS-treated group had a greater extent of COVID-19 lung involvement compared to the DEX-treated group (59.2% vs. 36.3%, p = 0.002), as well as longer hospital stays in both general ward (14.2 days vs. 10.6 days, p = 0.018) and ICU (5.4 days vs. 3 days, p = 0.017). The DEX and MPS-treated group also had a longer duration of steroid therapy (19.3 days vs. 12.3 days, p < 0.001) and received higher DEX-equivalent cumulative steroid doses (380 mg vs. 125 mg, p < 0.001). Notably, ONFH symptoms developed earlier in the DEX and MPS-treated group compared to the DEX-treated group (7.5 months vs. 12 months, p = 0.004). Multivariable logistic regression analysis identified cumulative steroid dose as the sole predictor of ONFH severity (OR: 1.015, 95% CI: 1.001-1.028, p = 0.032), with ARCO stage 3 patients receiving higher cumulative steroid doses than stage 2 patients (240 mg vs. 126 mg, p = 0.018).
Our study demonstrated that cumulative steroid dose is the primary determinant of ONFH severity in post-COVID-19 patients. Additionally, combined use of corticosteroids may accelerate the onset of ONFH, highlighting the need for cautious steroid management in COVID-19 patients.
新冠疫情已导致许多人死亡，并通过新冠后状况持续影响个人。股骨头坏死（ONFH）日益被认为是新冠后的一种主要并发症，但大多数研究仅限于病例报告和小样本系列研究。本研究旨在评估可能导致新冠后患者发生ONFH的新冠相关因素。
对84例确诊有新冠病史的ONFH患者进行回顾性分析。收集基线特征，并将患者分为以下几组进行比较分析：（1）接种疫苗组与未接种疫苗组；（2）单侧ONFH与双侧ONFH；（3）地塞米松（DEX）和甲泼尼龙（MPS）联合治疗组与DEX治疗组；（4）骨循环研究协会（ARCO）2期与3期。分析组间差异和关联。
与DEX治疗组相比，DEX和MPS联合治疗组的新冠肺部受累程度更高（59.2%对36.3%，p = 0.002），在普通病房的住院时间也更长（14.2天对10.6天，p = 0.018），在重症监护病房的住院时间也更长（5.4天对3天，p = 0.017）。DEX和MPS联合治疗组的类固醇治疗持续时间也更长（19.3天对12.3天，p < 0.001），接受的DEX等效累积类固醇剂量更高（380毫克对125毫克，p < 0.001）。值得注意的是，与DEX治疗组相比，DEX和MPS联合治疗组的ONFH症状出现更早（7.5个月对12个月，p = 0.004）。多变量逻辑回归分析确定累积类固醇剂量是ONFH严重程度的唯一预测因素（OR：1.015，95%CI：1.001 - 1.028，p = 0.032），ARCO 3期患者接受的累积类固醇剂量高于2期患者（240毫克对126毫克，p = 0.018）。
我们的研究表明，累积类固醇剂量是新冠后患者ONFH严重程度的主要决定因素。此外，联合使用皮质类固醇可能会加速ONFH的发病，这突出了对新冠患者进行谨慎类固醇管理的必要性。
