Screening for Femoral Head Osteonecrosis Following COVID-19: Is It Worth It?



1 Orthopedic Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

2 1 Orthopedic Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran 2 American Hip Institute, Chicago, Illinois, USA

3 UConn Health, Department of Orthopedic Surgery; Farmington, Connecticut, USA

4 Andrews Institute for Orthopedics and Sports Medicine; Gulf Breeze, FL, USA


Objectives: Based on WHO data, as of June 2022, there were 532.2 million confirmed COVID-19 cases globally.
In the initial phase of the COVID -19 pandemic, patients experiencing critical illness marked by severe respiratory
distress were commonly subjected to corticosteroid treatment. Regrettably, the administration of exogenous
corticosteroids stands as the prevailing cause of ONFH. In the current narrative review, we aim to evaluate if active
screening should be utilized to diagnose post-COVID-19 ONFH in its early stages.
Methods: The databases for PubMed, CINAHL, and Science Direct were systematically queried in March 2022.
The search terms were as follows: “COVID-19”, “severe acute respiratory syndrome”, “coronavirus”, “systemic
steroid”, “corticosteroid”, “femoral head osteonecrosis”, “avascular necrosis”, or “steroid therapy.” The included
studies for review were all required to be peer-reviewed studies in the English language with Reported complications
linked to steroid therapy in COVID-19 patients or potential connections to the development of ONFH in individuals
recovering from the novel coronavirus have been documented.
Results: Systemic corticosteroids were frequently employed in managing critically ill COVID-19 patients. The CDC
reports up to June 2022 showed more than 4.8 million COVID-19 hospitalizations in the US, with approximately over
one million patients receiving steroids. In a study of ONFH after infection with COVID-19, all patients had bilateral
involvement. The average duration from the initiation of corticosteroid treatment to the onset of symptoms was 132.8
Conclusion: In summary, a distinct correlation exists between the administration of steroids to individuals with COVID19 and the subsequent risk of ONFH. Moreover, an elevated dosage and prolonged duration of steroid therapy in
COVID-19 patients are associated with an increased likelihood of developing ONFH. Therefore, active screening for
high-risk patients, that may have received systemic corticosteroid treatment during a COVID-19 illness, may be
 Level of evidence: IV


Main Subjects

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