Avascular necrosis of the femur following COVID-19: an updated systematic review.
Mohaddeseh Azadvari, Nafiseh Akbari, Sepanta Hatam et al.
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In 30 seconds
This systematic review updated evidence on avascular necrosis (AVN) of the femoral head reported after COVID-19. Searches identified 55 studies, comprising four cross-sectional studies, six retrospective studies, and 45 case reports or case series, with 864 cases in total. Bilateral AVN was reported in 274 cases (31.7%). Steroid therapy was reported in 43 studies. Total hip arthroplasty was the most commonly used surgical treatment; some studies described symptomatic improvement after core decompression. The authors emphasize considering AVN in COVID-19 survivors and the potential value of early diagnosis for joint preservation.
Key findings
- The review included 55 studies and 864 cases; 45 studies were case reports or case series.
- Bilateral AVN involving both hips was reported in 274 cases (31.7%).
- Steroid therapy was reported in 43 of the 55 studies.
- Total hip arthroplasty was the most commonly used surgical treatment; some studies reported symptomatic improvement with core decompression.
Why it matters
The review brings together reports of femoral-head AVN after COVID-19, including its bilateral presentation and the treatments described. Awareness may support consideration of this complication in people who have survived COVID-19. The authors highlight early diagnosis as relevant to preserving the joint and its function, although the evidence summarized is largely observational and case-based.
What to keep in mind
Most included evidence came from case reports or case series, limiting conclusions about frequency, causation, and comparative treatment effectiveness.