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A Rise in Avascular Necrosis Cases Following Steroid Treatment for the COVID-19 Pandemic

The Role of Steroids as a Treatment for COVID-19

Since the beginning of the COVID-19 pandemic in 2019, a variety of treatment options have been used to treat those infected with the virus. Without a vaccine, the medical community has implemented different treatment options to combat the pandemic. A body of literature has supported the use of steroid based treatments for cases of COVID and other conditions. Through the course of the pandemic, over 50% of patients diagnosed with COVID have been treated with high doses of steroids. In the United Kingdom, the prescription rates of steroids have risen as well, with studies suggesting that over 1% of adults consume prescription steroids every day.

What is Avascular Necrosis?

Avascular Necrosis (AVN) is a rare orthopedic condition characterized by bone death and degeneration of surrounding structures in the joints like the hips, ankles, knees, and jaws. Traumatic injury and interactions from strong drugs, like steroids, are risk factors that cause a loss of circulation to healthy bones. In cases of AVN in the hip, the lack of circulation leads to malnourishment and dying of the bone cells along the femoral head (the ball) or the acetabulum (the socket). As the bony structures of the hip continue to degrade, the patient experiences debilitating pain and loss of function in the hip.

A Rise of Cases in Avascular Necrosis

As steroid treatments have become increasingly popular through the COVID-19 Pandemic, more individuals have been suffering from AVN. After the start of the COVID-19 pandemic, patients diagnosed and treated for COVID-19 have been reported to have a 30% higher incidence of AVN. Experts in healthcare believe that the increasing rates of AVN can be attributed to the growing prevalence of steroid treatments - the leading risk factor for AVN. The further implementation of steroid treatments will likely result in a growing demand for the few orthopedic centers who have the training and experience to treat AVN.

How is Avascular Necrosis Treated?

When a patient is diagnosed with AVN in the hip, there are a series of conservative measures that specialists offer. These measures include rest, non-steroidal inflammatory drugs (NSAIDs), and physical therapy. Conservative measures can help manage the pain of AVN and restore function to the hip, but will unlikely repair the degenerating anatomy of a hip with AVN. To restore the structure of the hip, a specialist can perform a variety of procedures to restore the hip anatomy at different stages of AVN.

The American Hip Institute specializes in treating AVN with arthroscopic assisted core decompression. This procedure uses a minimally invasive approach to remove dying bone within the femoral head to allow healthy bone to regrow, regain structural integrity, and prevent further progression of AVN. Three other common procedures for AVN are osteotomies, bone grafts, and total hip replacements. In an osteotomy, a surgeon can arthroscopically shape the bony structures of the hip to prevent future dysfunction in the hip. When bony structures surrounding the hip have significant damage, specialists can remove healthy bone from other parts of the body and replace dying bone tissue in the hip. In severe cases of AVN, a total hip replacement can be performed to restore the entire anatomy of the hip.

Consult with the American Hip Institute Team

The American Hip Institute has preserved and restored thousands of hips through thoughtful conservative treatment and cutting-edge procedures like arthroscopic assisted core decompression. If you are experiencing hip pain, our expert team can provide an accurate diagnosis and help you return to your favorite activities.

AUTHOR: Dr. Benjamin Domb, Founder and Medical Director at the American Hip Institute, is an orthopedic surgeon specializing in Sports Medicine and Hip Arthroscopy. Dr. Domb is rated among the Top Doctors in the USA by the NY Times, US News & World Report, and Castle Connelly.

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