Corticosteroids and rising tide in femoral head avascular necrosis following COVID-19: A critical analysis

Year 2025, Volume: 11 Issue: 2, 371 - 377

Levent Demir , Mustafa Avcı , Tuba Yücel Uçarkuş , Murat Kahraman , Mustafa Öztürk , Mehtap Şahingöz Tahta , Selahattin Kılıç

https://doi.org/10.18621/eurj.1607778

Abstract

Objectives: During the COVID-19 pandemic, increased corticosteroid use to treat severe cases has been linked to a rise in femoral head avascular necrosis (FHAVN) cases post-recovery. This study evaluated FHAVN patients referred to an outpatient clinic after COVID-19, focusing on the severity of FHAVN related to corticosteroid use, and aimed to connect the drug dosage, and disease grade.

Methods: The study was prospectively designed. Patients diagnosed with FHAVN who received corticosteroids for COVID-19 were included. Data collected included demographic information, medical history, corticosteroid dosage, and magnetic resonance imaging results for radiological grading.

Results: A total of 48 patients were evaluated, with a mean age of 46.13 years. A significant majority (81.3%) of the respondents had bilateral FHAVN. The patients received a mean prednisolone equivalent dose of 1295.16±857.98 mg over approximately 18 days. This study found a significant positive correlation between the severity of FHAVN and the dosage and total corticosteroid treatment time.

Conclusions: The findings indicate that the severity of FHAVN is correlated with corticosteroid use. Although corticosteroids have shown benefits in severe COVID-19 cases, their prolonged and high-dose administration poses risks, including the development of FHAVN.

Keywords

Avascular necrosis, corticosteroids, COVID-19

Ethical Statement

This study was approved by the Kayseri City Hospital Clinical Research Ethics Committee (Decision no: 738 and date: 08.11.2022).

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