Osteonecrosis of the femoral head after COVID-19: a case series

It is known that COVID-19 has an adverse effect on various organs and systems of the human body. In the available literature, there are isolated reports regarding the development of osteonecrosis after suffering COVID-19. These papers discuss the role of commonly used corticosteroids in the treatment of COVID-19 in the development of osteonecrosis. Our article presents clinical observations of four patients with bilateral osteonecrosis of the femoral heads after treatment with COVID-19. The doses of prednisolone in three patients were 4500 mg, 735 mg and 525 mg. One patient did not receive corticosteroids. Our data showed that osteonecrosis in COVID-19 survivors developed at a shorter time compared to osteonecrosis in patients without coronavirus infection. Two out of four patients had a positive family history (myocardial infarction, hypertension, thrombosis). It is possible that hereditary vascular factors played some role in the genesis of osteonecrosis of the femoral head. Further evidence is needed to understand the development of osteonecrosis after COVID-19. Probably, the development of the disease is synergistically affected by many factors, including steroid and ischemic.