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What Is Avascular Necrosis Occurring As Post-COVID Complication, Expert Explains

Steroids were administered to persons suffering from moderate to severe COVID-19, and avascular necrosis is a known side-effect of high steroid doses.

Varun Verma
Written by: Varun VermaUpdated at: Feb 06, 2023 13:49 IST
What Is Avascular Necrosis Occurring As Post-COVID Complication, Expert Explains

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Many people have experienced complications during their post-COVID recovery period. Formation of blood clots, new-onset diabetes, and fatigue are some of these common complications. However, many have even complained about Avascular Necrosis (AVN) after recovering from COVID-19. To know more about this health condition, its causes, and symptoms, the OnlyMyHealth editorial team talked to Dr Mohd Bilal Ahmed, Occupational Therapist, Mot (Neurology), 1323 Gali Kar Khaney Wali Tilak Bazar, Delhi, 110006

What Is Avascular Necrosis?

Avascular necrosis is a condition that develops when there is a loss of blood from the bones. Since bones are also living tissues, they require blood to flourish. When the blood supply to the bones is hindered, they cease to grow and ultimately die. If this is not stopped timely, it can eventually lead to bone collapse. 

What Does Avascular Necrosis Affect?

Also known as osteonecrosis, aseptic necrosis, or ischemic bone necrosis, this condition most commonly affects the hip. For other parts of the body, AVN can affect shoulders, knees, and ankles.

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What Are The Causes Of Avascular Necrosis?

There are many causes of avascular necrosis, including acute trauma, steroid therapy, alcoholism, sickle cell anaemia, collagen vascular diseases like SLE, Gaucher's disease, radiation therapy, and metabolic diseases (hyperlipidemia, gout, renal failure).

Why Is Avascular Necrosis Rising After COVID Recovery?

According to Dr Bilal, steroids were administered to persons suffering from moderate to severe COVID-19 during the second wave to reduce the inflammatory response and lung injury caused by the viral infection. He said that AVN is a known side-effect of high doses of steroids. This is because corticosteroids can increase lipid levels in the blood and reduce blood flow. The head of the hip joint, which is a major weight-bearing joint, has a precarious blood supply. That is why it is most vulnerable for AVN under stressful circumstances.

Management Principle Of Avascular Necrosis

The treatment goal for avascular necrosis is to improve and ensure the affected joint's function to stop the progression of bone damage and reduce pain. The best course of treatment will depend on several factors, including age, stage of the disease, location and amount of bone damage, and cause of the disease, emphasised Dr Bilal.

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The treatment involves three stages, namely the early stage, intermediate stage, and late stage.

Early Stage (I & II) Treatment

This stage involves bisphosphonates that prevent collapse, unloading, osteotomies, medullary decompression, and bone grafting.

Intermediate Stage (III & IV) Treatment

In the intermediate stage of avascular necrosis, realignment, osteotomies, decompression, and arthrodesis are done to improve the condition.

Late Stage (V & VI) Treatment

In the late-stage treatment of avascular necrosis, analgesia, activity modification, arthrodesis, and arthroplasties are done.

Conservative Management Of Avascular Necrosis 

Further, according to Dr Bilal, there is conservative management of avascular necrosis. In this regime, offloading is done on affected joints with the use of crutches. Additionally, immobilisation, analgesia, and bisphosphonates are done to delay the femoral head collapse. Statins are administered to patients who are on high-dose corticosteroids to reduce lipid deposition.

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