Post-COVID-19 Steroid-Induced Avascular Necrosis of the Hip: Does Severity of Infection Influence Functional Outcome?

BACKGROUND

Corticosteroids are widely used in the treatment of moderate and severe coronavirus disease 2019 (COVID-19), but their association with avascular necrosis (AVN) of the femoral head has raised concern. This study aimed to evaluate the association between the severity of COVID-19 and functional outcome in patients undergoing total hip replacement (THR) for post-COVID-19 steroid-induced AVN.

METHODS

This prospective observational study was conducted on 26 patients diagnosed with steroid-induced AVN of the femoral head following moderate or severe COVID-19 infection. All patients underwent cementless THR. The severity of COVID-19, steroid exposure, time to symptom onset, and preoperative and postoperative hip function were recorded. Functional outcome was assessed using the modified Harris hip score (MHHS) at 12 months.

RESULTS

Patients with severe COVID-19 had a significantly higher total dose and longer steroid exposure (mean 2759.1 mg, 25.76 days) and earlier onset of hip pain (mean 54.1 days) than those with moderate infection (mean 1248.8 mg; 16.8 days, and 81.2 days, respectively). Both groups showed significant improvement in postoperative MHHS, with the moderate group achieving slightly higher scores (mean 89.2 vs. 85.8). The severity of AVN, total steroid dose, and duration had no significant association with outcome.

CONCLUSION

While THR provided satisfactory outcomes in all cases, patients with moderate COVID-19 exhibited marginally better functional recovery, suggesting that infection severity and steroid burden may influence postoperative prognosis.