Increase in cases of Avascular Necrosis in post COVID patients leading to chronic hip pain & disability

Gurugram: Incidences of Avascular Necrosis (death of bone tissue due to a lack of blood supply) has notably risen in the last year, suggests patient data from Artemis Hospital, Gurugram. Use of Steroids increased in covid 19 Pandemic period to reduce the severity of infection and was one of important life saving measures. However, this has resulted in increased cases of hip pain and disability post covid pandemic.

The hospital has witnessed 20% increase in AVN cases, and the requirement of surgery has also increased by roughly 20% in the last one year.

Dr Ramkinkar Jha, Chief and Unit Head – Orthopaedics, Artemis Hospital Gurugram, informs, “Incidence of Avascular necrosis of femoral head (hip) has increased in last two years.  Steroids are one of important known factor causing avascular necrosis of femoral head (hip joint). Excessive/ injudicious uses of steroids may be factor behind this trend. We are also witnessing higher Incidence of AVN seen in younger population which is a major deviation from earlier. Younger age group, male population, persons with other comorbidities like diabetes and respiratory issues are specifically more affected. We have also witnessed patient cases from rural and remote places having unexplained pain around hip joint when investigated found to be suffering from this disease.”

Avascular Necrosis of femoral head or simply AVN hip joint is one of important etiology of arthritis of hip. Avascular necrosis is the death of bone tissue due to a lack of blood supply and it most commonly affects the femur (thigh bone) and damages one of the most important weight bearing joints in the body.

Dr Ramkinkar Jha adds, “AVN has different stages and is broadly divided into two categories. First is pre-collapse state where pain is only symptoms of complaint by patients. In this state shape of femoral head is well preserved and if treated well chances of further progression may be prevented. Next category is post-collapse state where femoral head is collapsed, hip joint becomes arthritic and all movements at hip joint are painful. Patients have difficulty in doing their regular work leading to disability.”

In the pre-collapse state, where the shape of femoral head is preserved, core decompression with or without bone grafting is recommended. This is done in conjugation with some specialized medications given in hope that collapse can be prevented. Whereas, when femoral head has collapsed then there are only a few alternatives, osteotomy is one of option. Total Hip Replacement surgery is recommended only as the last option.

Dr Ramkinkar Jha, elaborates, “the major challenges with core decompression is the limited success rate. In non-steroid AVN, stage one and two, success rates vary between 30 to 60 percent, but in steroid induced cases this reduced to 20 to 30 percent. Early detection is the key. Another preventive measure is avoidance of taking spurious medications where chances of steroids mixing is very high. Early treatments with specialized medications prescribed by physician is very important. AVN if untreated, can result in the total collapse of the femur neck (at the weakest point) and may require emergency surgery.”