Bone death amid COVID recovered patients worrisome

After Mucormycosis, cases of “Bone Death” or Avascular Necrosis of bone have been on a rise in patients who have been treated for severe covid 19 infections. Avascular necrosis is a condition of death of bone tissue when the blood supply becomes inadequate or obstructed due to any reason. Most common sites for avascular necrosis are hip joints, others being knee, ankle and shoulder joints. Due to shortage of blood supply, the bone death occurs, and dead bone develops cracks and finally collapses, causing severe pain in the joint. And if one thinks that they have completely recovered from COVID-19, it may not be the time yet to let the guard down. The post complications of COVID has not only given rise to the cases of black fungus (mucormycosis), but a new deadly ailment as well. Cases of bone death has been recorded to be on an exponential rise among those patients who have recently recovered from severe COVID infection. These complications have been reported as ‘Long COVID” by the scientific community wherein a patient continues to experience symptoms of the disease four to six weeks after the initial recovery and has seen complications in the lung, kidney, heart and cases of mucormycosis – headlined as ‘black fungus’.
Patients with early stage AVN can be successfully treated medically, without any surgery, with Bisphosphonate therapy. Surgical Intervention may be prevented!
Like mucormycosis, Bone death is also linked to excessive steroid use during the treatment of COVID 19. Apart from usage of corticosteroids, which is a common cause for the development of Avascular Necrosis of the bone, thromboembolism is another likely cause to obstruct the blood supply to the bone of hip joint thereby causing death of bone. This eventually leads to arthritis of the joint involved, causing pain and stiffness, limiting the motion of the joint. Now for the first time in medical literature, Doctors have recovered patients of COVID-19 being afflicted with Avascular necrosis (AVN) or Osteonecrosis – a painfully crippling condition affecting hips of patients. The doctors have written a medical paper on their findings, which has been accepted for publication by the British Medical Journal (BMJ) case reports. COVID survivors, who have been on steroids, and then develop hip or thigh pain – need confirmatory MRI to establish a diagnosis of AVN (osteonecrosis) of the hip. This condition can then be successfully treated and if picked up early CAN be reversed. Patients with early stage AVN can be successfully treated medically, without any surgery, with Bisphosphonate therapy. Surgical Intervention may be prevented!
(The author is Director – Professional Services, Head – Orthopaedics & Traumatology at P. D. Hinduja Hospital New Delhi. Views are his own)