A cross-sectional study to evaluate the correlation of covid-19 infection with avascular necrosis of hip joint

Abstract

Background: Avascular necrosis (AVN) of the hip is a progressive and disabling condition resulting from compromised blood supply to the femoral head. During the COVID-19 pandemic, increasing reports of post-COVID musculoskeletal complications have raised concern regarding a possible association between SARS-CoV-2 infection and AVN, particularly in the setting of corticosteroid use and COVID-19–related vascular injury. However, available evidence remains limited, especially from the Indian population. The present study aimed to evaluate the correlation between prior COVID-19 infection and avascular necrosis of the hip joint and to analyze demographic characteristics, disease severity, steroid exposure, and time to onset in a tertiary care setting.Methods: This cross-sectional observational study was conducted in the Department of Orthopaedics at a tertiary care center over one year. Sixty patients diagnosed with idiopathic AVN of the hip were included. Clinical history focusing on COVID-19 infection, steroid therapy, and symptom onset was recorded. Radiological assessment using X-ray and MRI was performed, and AVN was graded using the Ficat and Arlet classification. Data were analyzed using descriptive statistics.Results: The mean age of patients was 38.78 ± 10.58 years, with a male predominance of 75%. Grade 2 AVN was the most common stage (40%), followed by Grade 3 (30%) and Grade 4 (26.7%). Bilateral hip involvement was observed in 61.7% of cases. Twenty patients (33.3%) had a history of COVID-19 infection, among whom Grade 2 and Grade 3 AVN predominated. Only 35% of COVID-19–positive patients had documented steroid exposure. The mean interval between COVID-19 infection and AVN onset was 6.53 months.Conclusion: The study suggests a possible association between COVID-19 infection and AVN of the hip, with evidence supporting a multifactorial pathogenesis beyond steroid exposure alone. Long-term surveillance and early evaluation of hip symptoms in post-COVID patients are essential.