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

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 respiratorydistress were commonly subjected to corticosteroid treatment. Regrettably, the administration of exogenouscorticosteroids stands as the prevailing cause of ONFH. In the current narrative review, we aim to evaluate if activescreening should be utilized to diagnose post-COVID-19 ONFH in its early stages.

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”, “systemicsteroid”, “corticosteroid”, “femoral head osteonecrosis”, “avascular necrosis”, or “steroid therapy.” The includedstudies for review were all required to be peer-reviewed studies in the English language with Reported complicationslinked to steroid therapy in COVID-19 patients or potential connections to the development of ONFH in individualsrecovering from the novel coronavirus have been documented.

Systemic corticosteroids were frequently employed in managing critically ill COVID-19 patients. The CDCreports up to June 2022 showed more than 4.8 million COVID-19 hospitalizations in the US, with approximately overone million patients receiving steroids. In a study of ONFH after infection with COVID-19, all patients had bilateralinvolvement. The average duration from the initiation of corticosteroid treatment to the onset of symptoms was 132.8days.

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 inCOVID-19 patients are associated with an increased likelihood of developing ONFH. Therefore, active screening forhigh-risk patients, that may have received systemic corticosteroid treatment during a COVID-19 illness, may bereasonable. Level of evidence: IV