Annapareddy Adarsh, Mulpur Praharsha, Jayakumar Tarun, Boddeda Sandeep, Mahajan Aakarsh, Prasad Vemaganti Badri Narayana, Reddy A V Gurava
Orthopaedics, Sunshine Bone and Joint Institute, KIMS-Sunshine Hospitals, Hyderabad, IND.
Cureus. 2025 Jul 3;17(7):e87230. doi: 10.7759/cureus.87230. eCollection 2025 Jul.
Avascular necrosis (AVN) of the femoral head has been observed to occur after COVID-19, especially if steroids were taken. However, the knowledge about its progress in these cases is lacking. We aimed to evaluate the progress of a disease after post-COVID AVN and the effect of various treatments.
This was a retrospective observational study conducted on 118 patients (212 hips) diagnosed with hip AVN following COVID-19 infection between June 2021 and September 2021. Patients were followed up for a minimum duration of 2 years and evaluated based on demographics, Ficat and Arlet staging, corticosteroid usage, and assessment of treatment modality outcomes. Harris Hip Scores (HHS) were recorded at presentation, 3 months, and 2 years.
The mean age of the cohort was 36.8 years (SD: 10.9), with a majority of males (N=103, 87.3%). The mean interval between the diagnosis of COVID-19 and the onset of hip symptoms was 10.8 months (range: 1-24 months; SD: 5.9) and the mean interval between the onset of hip symptoms and the diagnosis of AVN was 3.65 weeks (range: 1-8 weeks; SD: 1.9), indicating the rapid progress of the disease. The majority of them presented with bilateral AVN (79.7%), with Ficat and Arlet Grade 2 (50.9%) and Grade 3 (41%) AVN, respectively. The mean cumulative steroid dose (prednisolone equivalents) was 439.27 mg (SD: 583.29), with a mean duration of 12.76 days (SD: 12.3). Patients managed conservatively showed an initial improvement in HHS from 77.3 (SD: 11) at presentation to 88.4 (SD: 7.6) at 3 months but declined to 81.8 (SD: 9.7) at 2 years (p<0.001). Core decompression alone resulted in a decline from 73 (SD: 13.5) to 69.5 (SD: 12) at 2 years. In contrast, total hip arthroplasty (THA) led to significant improvement from 64.4 (SD: 12.4) to 92.4 (SD: 3.3) at 2 years (p<0.001).
Post-COVID-19 AVN is an aggressive and rapidly progressing condition affecting young individuals, even with relatively low corticosteroid exposure. Conservative treatments provide only transient benefit, while THA offers substantial and sustained functional improvement in advanced AVN. Early identification and timely surgical intervention, where indicated, are crucial to optimizing patient outcomes in clinical practice.
已观察到新型冠状病毒肺炎（COVID-19）后会发生股骨头缺血性坏死（AVN），尤其是在使用类固醇药物的情况下。然而，对于这些病例中其病情进展的了解尚不足。我们旨在评估COVID-19后AVN疾病的进展情况以及各种治疗方法的效果。
这是一项回顾性观察研究，对2021年6月至2021年9月期间确诊为COVID-19感染后髋部AVN的118例患者（212髋）进行了研究。对患者进行了至少2年的随访，并根据人口统计学、菲卡特（Ficat）和阿莱特（Arlet）分期、皮质类固醇使用情况以及治疗方式效果评估进行分析。在就诊时、3个月和2年时记录Harris髋关节评分（HHS）。
该队列的平均年龄为36.8岁（标准差：10.9），大多数为男性（n = 103，87.3%）。COVID-19诊断至髋部症状出现的平均间隔时间为10.8个月（范围：1 - 24个月；标准差：5.9），髋部症状出现至AVN诊断的平均间隔时间为3.65周（范围：1 - 8周；标准差：1.9），表明疾病进展迅速。大多数患者表现为双侧AVN（79.7%），菲卡特和阿莱特分级分别为2级（50.9%）和3级（41%）AVN。皮质类固醇的平均累积剂量（泼尼松等效剂量）为439.27毫克（标准差：583.29），平均使用时长为12.76天（标准差：12.3）。保守治疗的患者HHS最初从就诊时的77.3（标准差：11）改善至3个月时的88.4（标准差：7.6），但在2年时降至81.8（标准差：9.7）（p<0.001）。单纯髓芯减压在2年时HHS从73（标准差：13.5）降至69.5（标准差：12）。相比之下，全髋关节置换术（THA）在2年时从64.4（标准差：12.4）显著改善至92.4（标准差：3.3）（p<0.001）。
COVID-19后AVN是一种侵袭性且进展迅速的疾病，影响年轻个体，即使皮质类固醇暴露量相对较低。保守治疗仅提供短暂益处，而THA在晚期AVN中可带来显著且持续的功能改善。在临床实践中，早期识别并在必要时及时进行手术干预对于优化患者预后至关重要。
