Doctors see rise in Avascular Necrosis cases in recovered Covid patients

AVN is a disease that results from the temporary or permanent loss of blood supply to the bones

48-year-old Vikram Reddy, a businessman, had contracted Covid in September last year and two months later developed back pain. An MRI revealed Avascular Necrosis (AVN), a disease that results from the temporary or permanent loss of blood supply to the bones. When blood supply is cut off, the bone tissue dies and the bone collapses.

DH spoke with several city orthopaedic surgeons who confirmed Covid patients post recovery facing this problem, and have warned against excessive use of steroids. Another reason is that since the clotting tendency of the body generally increases due to Covid, blood supply to some areas stops in some patients who have also taken steroids.

Treatment with bisphosphonates tablets stalled worsening of Vikram's condition, but it still persists. Standing up for long hours leads to pain and his daily routine has been hampered due to activity restriction. This is the first time he has developed an orthopaedic problem in his life.

To treat his Covid last year, he had no choice but to be administered with steroids, which his treating doctor believes is the reason for him getting AVN.

His wife Sangeetha Reddy, 45, who also recovered from Covid but did not develop AVN, told DH, "We took a few steroids because the CORAD (Covid-19 Reporting and Data System) score increased from four to nine in five days. When it was spreading rapidly, the pulmonologist took a call to give steroids.

"Maybe AVN was a complication due to steroids but at that point of time what choice did we have? From our experience, I suggest recovered Covid patients to watch out for back and joint pain at least for a year. Second wave's complications are worse compared to the first wave."

Dr Raghu Nagaraj, specialist in knee and shoulder surgery, who treated Vikram, said, "I have seen two AVN patients so far. Both had Covid in October and had back pain three months down the line.

"In grade one and two of AVN, we do core decompression where we drill multiple holes into the head of the femur (ball). Hip joint is a ball in a socket. In AVN, the ball becomes dead. The blood supply to the ball stops. So the soft nature of the ball becomes hard. The smooth, round nature of the ball becomes mush," the doctor said.

Core decompression is a surgical procedure that involves surgical drilling into the area of dead bone near the joint. This reduces pressure, allows increased blood flow, and slows or stops bone or joint destruction.

Dr Deepak S, former president of Bangalore Orthopaedic Society, and Special Officer, Trauma and Emergency Care Centre, said, "Cases are slowly creeping up. What we are seeing now are patients who have taken steroids in the first wave. But steroids are the most important drugs to save lives from Covid. So it is inevitable for some minimal percentage of cases to have AVN."

Dr Ranjith SDI, an expert in hip reconstruction, who runs Swarnarani Orthopaedic clinic in Vidyaranyapura, said, "AVN can occur in many bones, hip bone being one of them. There are many causes of AVN too, one of them being steroid intake. During this pandemic, many Covid patients have consumed steroids with or without prescriptions."

"High doses can cause AVN. Surgery is indicated in some, not all, depending on whether it is the late stage. If the ball has deformed and is causing wear and tear (arthritis), then the only option is a hip replacement. For younger patients we do a high performance hip replacement, for older ones routine replacement is done," he added.