Ortopedik açıdan Covid-19'un bıraktıkları: Femur başı avasküler nekrozu

Abstract

Amaç: Covid-19 pandemisi sonrasında kliniğimizde femur başı Avasküler Nekrozu (AVN) olgularının sayısında artış gözlemledik. Bu çalışmanın amacı COVID-19 sonrası femur başı AVN vakalarında anlamlı bir artış olup olmadığını araştırmak ve bu hastaların tedavisinde kullanılan steroid tedavilerinin etkilerini incelemektir. Gereç ve Yöntemler: Hastanemizde 2018-2023 yıllarına ait hasta kayıtlarının kapsamlı bir retrospektif incelemesini yapıldı. Femur başı AVN tanısı alan hastaları belirlendi ve demografik verileri, başvuru tarihleri, şikayet dönemleri, COVID-19 tanıları, yoğun bakım tedavileri ve steroid kullanımları kaydedildi. Bulgular: Hastanemizde son altı yılın kayıtları incelendiğinde, 26 hastanın femur başı AVN tanısı aldığı tespit edildi. Bu hastalardan 5'i (%19,2) ülkemizdeki ilk COVID-19 vakasının görüldüğü Mart 2020 tarihinden önce, 21'i (%80,8) ise bu tarihten sonra tanı almıştır. Yıllara göre dağılım incelendiğinde 2022 yılında 10 (%38,4) hastanın, 2023 yılında ise 8 (%30,7) hastanın başvurduğu, bunun da Covid-19 öncesi yıllara göre hastane ortalamasının yaklaşık dört katına denk geldiği görüldü. Sonuç: COVID-19'un neden olduğu dolaşım sorunları femur başı AVN gelişimi için bir risk faktörü olabilir. Ayrıca, pandemi döneminde kortikosteroidler yaygın olarak kullanıldığından, gelecekte femur başı AVN vakalarında artış olabilir.

Keywords

• Femur başı nekrozu
• COVID-19
• kalça

What Covid-19 left behind in orthopedics: Avascular necrosis of the femoral head

Abstract

Aim: Following the COVID-19 pandemic, a rise in the number of femoral head avascular necrosis (AVN) cases in orthopedic clinics was detected. The purpose of the current study was to research whether there has been a significant increase in femoral head AVN cases after COVID- 19, and to examine the effects of COVID-19 and steroid treatments used in the care of these patients. Material and Methods: A comprehensive retrospective review of patient records from 2018 to 2023 was conducted in our hospital. In this study, patients diagnosed with femoral head AVN and treated were recorded. We identified patients diagnosed with femoral head AVN and recorded their demographic data, admission dates, complaint periods, COVID-19 status, intensive care treatment, and steroid use. Results: When examining the records of the past six years at our hospital, 26 patients were found to have been diagnosed with femoral head avn. Of these patients, 5 (19.2%) were diagnosed before March 2020, the first Covid-19 case in our country, while 21 (80.8%) were diagnosed after this date. Examining the distribution by year, it was found that 10 (38.4%) patients applied in 2022 and 8 (30.7%) patients in 2023, which is approximately four times the annual hospital average before COVID- 19. Conclusion: Circulation problems caused by COVID-19 may be a risk factor for femoral head AVN. In addition, since corticosteroids were widely used during the pandemic, there may be an increase in cases of femoral head AVN in the future.

Keywords

• Femur head necrosis
• COVID-19
• hip

References

1. Piret J, Boivin G. Pandemics Throughout History. Front Microbiol. 2021;11:631736. https://doi.org/10.3389/fmicb.2020.631736
2. Becker RC. COVID-19-associated vasculitis and vasculopathy. J Thromb Thrombolysis. 2020;50(3):499-511. https://doi.org/10.1007/s11239-020-02230-4
3. Fahmy OH, Daas FM, Salunkhe V, Petrey JL, Cosar EF, Ramirez J, et al. Is Microthrombosis the Main Pathology in Coronavirus Disease 2019 Severity?-A Systematic Review of the Postmortem Pathologic Findings. Crit Care Explor. 2021;3(5):e0427. https://doi.org/10.1097/CCE.0000000000000427
4. Annane D. Corticosteroids for COVID-19. J Intensive Med. 2021;1(1):14-25. https://doi.org/10.1016/j.jointm.2021.01.002
5. Seamon J, Keller T, Saleh J, Cui Q. The pathogenesis of nontraumatic osteonecrosis. Arthritis. 2012;2012:601763. https://doi.org/10.1155/2012/601763
6. Konarski W, Poboży T, Śliwczyński A, Kotela I, Krakowiak J, Hordowicz M, et al. Avascular Necrosis of Femoral Head-Overview and Current State of the Art. Int J Environ Res Public Health. 2022;19(12):7348. https://doi.org/10.3390/ijerph19127348
7. Petek D, Hannouche D, Suva D. Osteonecrosis of the femoral head: pathophysiology and current concepts of treatment. EFORT Open Rev. 2019;4(3):85-97. https://doi.org/10.1302/2058-5241.4.180036
8. Griffith JF, Antonio GE, Kumta SM, Hui DS, Wong JK, Joynt GM, et al. Osteonecrosis of hip and knee in patients with severe acute respiratory syndrome treated with steroids. Radiology. 2005;235(1):168-175. https://doi.org/10.1148/radiol.2351040100

9. Hong N, Du XK. Avascular necrosis of bone in severe acute respiratory syndrome. Clin Radiol. 2004;59(7):602-608. https://doi.org/10.1016/j.crad.2003.12.008
10. Lv H, de Vlas SJ, Liu W, Wang TB, Cao ZY, Li CP, et al. Avascular osteonecrosis after treatment of SARS: a 3-year longitudinal study. Trop Med Int Health. 2009;14 Suppl 1(Suppl 1):79-84. https://doi.org/10.1111/j.1365-3156.2008.02187.x
11. Tang WM, Chiu KY. Avascular necrosis of femoral head: a short review. Aplar Journal of Rheumatology. 2006; 9(1), 98-101.
12. Zhang S, Wang C, Shi L, Xue Q. Beware of Steroid-Induced Avascular Necrosis of the Femoral Head in the Treatment of COVID-19-Experience and Lessons from the SARS Epidemic. Drug Des Devel Ther. 2021;15:983-995. https://doi.org/10.2147/DDDT.S298691.
13. Agarwala SR, Vijayvargiya M, Pandey P. Avascular necrosis as a part of ‘long COVID-19’. BMJ Case Rep. 2021;14(7):e242101. https://doi.org/10.1136/bcr-2021-242101
14. Dhanasekararaja P, Soundarrajan D, Kumar KS, Pushpa BT, Rajkumar N, Rajasekaran S. Aggressive Presentation and Rapid Progression of Osteonecrosis of the Femoral Head After COVID-19. Indian J Orthop. 2022;56(7):1259-1267. https://doi.org/10.1007/s43465-022-00635-2
15. Ravshanov Z, Khamidov O. Osteonecrosis of the femoral head after COVID-19: a case series. Uzbek journal of case reports. 2022;2(1):13-17. https://doi.org/10.55620/ujcr.2.1.2022.2
16. Sulewski A, Sieroń D, Szyluk K, Dąbrowski M, Kubaszewski Ł, Lukoszek D, et al. Avascular Necrosis Bone Complication after Active COVID-19 Infection: Preliminary Results. Medicina (Kaunas). 2021;57(12):1311. https://doi.org/10.3390/medicina57121311