Osteonecrosis of the femoral head in post-COVID-19 patients: a retrospective comparative study

被引：0
作者：
Jichang Seong [1 ]
Abduaziz Babakulov [2 ]
Saodat Asilova [3 ]
Babamukhamedova Shakhnoza [1 ]
Makhmudova Nodira [1 ]
Akbarjon Mirzayev [2 ]
机构：
[1] School of Medicine, Central Asian University, Tashkent
[2] Department of Orthopedics and Traumatology, Akfa Medline University Hospital, Tashkent
[3] Department of Orthopedics and Traumatology, Kimyo University Hospital, Tashkent
来源：
Journal of Orthopaedic Surgery and Research | / 20卷 / 1期
关键词：
Avascular necrosis; COVID-19; Dexamethasone; Femoral head; Methylprednisolone; Osteonecrosis; Steroid; Vaccination;
D O I：
10.1186/s13018-025-05657-8
中图分类号：
学科分类号：
摘要：
Background: 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. Methods: 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. Results: 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). Conclusions: 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. © The Author(s) 2025.
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  • [1] Cucinotta D., Vanelli M., WHO declares COVID-19 a pandemic, Acta Biomed, 91, 1, pp. 157-160, (2020)
  • [2] Yuki K., Fujiogi M., Koutsogiannaki S., COVID-19 pathophysiology: A review, Clin Immunol, 215, (2020)
  • [3] COVID-19 Epidemiological Update– Edition 175, (2024)
  • [4] Giordano L., Cipollaro L., Migliorini F., Maffulli N., Impact of Covid-19 on undergraduate and residency training, Surgeon, 19, 5, pp. e199-e206, (2021)
  • [5] Nalbandian A., Desai A.D., Wan E.Y., Post-COVID-19 condition, Annu Rev Med, 74, pp. 55-64, (2023)
  • [6] Mehta O.P., Bhandari P., Raut A., Kacimi S.E.O., Huy N.T., Coronavirus disease (COVID-19): comprehensive review of clinical presentation, Front Public Health, 8, (2020)
  • [7] Disser N.P., De Micheli A.J., Schonk M.M., Konnaris M.A., Piacentini A.N., Edon D.L., Et al., Musculoskeletal consequences of COVID-19, J Bone Joint Surg Am, 102, 14, pp. 1197-1204, (2020)
  • [8] Hogea B., Suba M.I., Abu-Awwad S.A., Cuntan P., Popa M.V., Braescu R.D., Et al., Exploring the association between COVID-19 and femoral head necrosis: A comprehensive review, Life (Basel), 14, 6, (2024)
  • [9] Petek D., Hannouche D., Suva D., Osteonecrosis of the femoral head: pathophysiology and current concepts of treatment, EFORT Open Rev, 4, 3, pp. 85-97, (2019)
  • [10] Larson E., Jones L.C., Goodman S.B., Koo K.H., Cui Q., Early-stage osteonecrosis of the femoral head: where are we and where are we going in year 2018?, Int Orthop, 42, 7, pp. 1723-1728, (2018)
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