Osteonecrosis of the femoral head in post-COVID-19 patients: a retrospective comparative study
Abstract Background The COVID-19 pandemic has claimed many lives and continues to impact individuals through post-COVID-19 conditions. Osteonecrosis of the femoral head (ONFH) is increasingly recognized as a major post-COVID-19 complication, yet most studies are limited to case reports and small ser...
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| Format: | Article |
| Language: | English |
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BMC
2025-04-01
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| Series: | Journal of Orthopaedic Surgery and Research |
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| Online Access: | https://doi.org/10.1186/s13018-025-05657-8 |
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| author | Jichang Seong Abduaziz Babakulov Saodat Asilova Babamukhamedova Shakhnoza Makhmudova Nodira Akbarjon Mirzayev |
| author_facet | Jichang Seong Abduaziz Babakulov Saodat Asilova Babamukhamedova Shakhnoza Makhmudova Nodira Akbarjon Mirzayev |
| author_sort | Jichang Seong |
| collection | DOAJ |
| description | Abstract Background The COVID-19 pandemic has claimed many lives and continues to impact individuals through post-COVID-19 conditions. Osteonecrosis of the femoral head (ONFH) is increasingly recognized as a major post-COVID-19 complication, yet most studies are limited to case reports and small series. This study aimed to evaluate COVID-19-related factors potentially contributing to ONFH development in post-COVID-19 patients. Methods A retrospective analysis was conducted on 84 patients with ONFH and a confirmed history of COVID-19. Baseline characteristics were collected, and patients were categorized into the following groups for comparative analysis: (1) vaccinated vs. unvaccinated, (2) unilateral vs. bilateral ONFH, (3) dexamethasone (DEX) and methylprednisolone (MPS) vs. DEX therapy, and (4) Association Research Circulation Osseus (ARCO) stage 2 vs. stage 3. Group differences and associations were analyzed. Results The DEX and MPS-treated group had a greater extent of COVID-19 lung involvement compared to the DEX-treated group (60% vs. 30%, p = 0.002), as well as longer hospital stays in both general ward (14.2 days vs. 10.6 days, p = 0.018) and ICU (5.5 days vs. 2 days, p = 0.020). The DEX and MPS-treated group also had a longer duration of steroid therapy (19.3 days vs. 12.3 days, p < 0.001) and received higher DEX-equivalent cumulative steroid doses (380 mg vs. 125 mg, p < 0.001). Notably, ONFH symptoms developed earlier in the DEX and MPS-treated group compared to the DEX-treated group (7.5 months vs. 12 months, p = 0.004). Multivariable logistic regression analysis identified cumulative steroid dose as the sole predictor of ONFH severity (OR: 1.015, 95% CI: 1.001–1.028, p = 0.032), with ARCO stage 3 patients receiving higher cumulative steroid doses than stage 2 patients (240 mg vs. 126 mg, p = 0.018). Conclusions Our study demonstrated that cumulative steroid dose is the primary determinant of ONFH severity in post-COVID-19 patients. Additionally, combined use of corticosteroids may accelerate the onset of ONFH, highlighting the need for cautious steroid management in COVID-19 patients. |
| format | Article |
| id | doaj-art-e479bafe5c564e38b238e96e325d7b80 |
| institution | Kabale University |
| issn | 1749-799X |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj-art-e479bafe5c564e38b238e96e325d7b802025-08-24T11:40:28ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2025-04-0120111110.1186/s13018-025-05657-8Osteonecrosis of the femoral head in post-COVID-19 patients: a retrospective comparative studyJichang Seong0Abduaziz Babakulov1Saodat Asilova2Babamukhamedova Shakhnoza3Makhmudova Nodira4Akbarjon Mirzayev5School of Medicine, Central Asian UniversityDepartment of Orthopedics and Traumatology, Akfa Medline University HospitalDepartment of Orthopedics and Traumatology, Kimyo University HospitalSchool of Medicine, Central Asian UniversitySchool of Medicine, Central Asian UniversityDepartment of Orthopedics and Traumatology, Akfa Medline University HospitalAbstract Background The COVID-19 pandemic has claimed many lives and continues to impact individuals through post-COVID-19 conditions. Osteonecrosis of the femoral head (ONFH) is increasingly recognized as a major post-COVID-19 complication, yet most studies are limited to case reports and small series. This study aimed to evaluate COVID-19-related factors potentially contributing to ONFH development in post-COVID-19 patients. Methods A retrospective analysis was conducted on 84 patients with ONFH and a confirmed history of COVID-19. Baseline characteristics were collected, and patients were categorized into the following groups for comparative analysis: (1) vaccinated vs. unvaccinated, (2) unilateral vs. bilateral ONFH, (3) dexamethasone (DEX) and methylprednisolone (MPS) vs. DEX therapy, and (4) Association Research Circulation Osseus (ARCO) stage 2 vs. stage 3. Group differences and associations were analyzed. Results The DEX and MPS-treated group had a greater extent of COVID-19 lung involvement compared to the DEX-treated group (60% vs. 30%, p = 0.002), as well as longer hospital stays in both general ward (14.2 days vs. 10.6 days, p = 0.018) and ICU (5.5 days vs. 2 days, p = 0.020). The DEX and MPS-treated group also had a longer duration of steroid therapy (19.3 days vs. 12.3 days, p < 0.001) and received higher DEX-equivalent cumulative steroid doses (380 mg vs. 125 mg, p < 0.001). Notably, ONFH symptoms developed earlier in the DEX and MPS-treated group compared to the DEX-treated group (7.5 months vs. 12 months, p = 0.004). Multivariable logistic regression analysis identified cumulative steroid dose as the sole predictor of ONFH severity (OR: 1.015, 95% CI: 1.001–1.028, p = 0.032), with ARCO stage 3 patients receiving higher cumulative steroid doses than stage 2 patients (240 mg vs. 126 mg, p = 0.018). Conclusions Our study demonstrated that cumulative steroid dose is the primary determinant of ONFH severity in post-COVID-19 patients. Additionally, combined use of corticosteroids may accelerate the onset of ONFH, highlighting the need for cautious steroid management in COVID-19 patients.https://doi.org/10.1186/s13018-025-05657-8Avascular necrosisCOVID-19DexamethasoneFemoral headMethylprednisoloneOsteonecrosis |
| spellingShingle | Jichang Seong Abduaziz Babakulov Saodat Asilova Babamukhamedova Shakhnoza Makhmudova Nodira Akbarjon Mirzayev Osteonecrosis of the femoral head in post-COVID-19 patients: a retrospective comparative study Journal of Orthopaedic Surgery and Research Avascular necrosis COVID-19 Dexamethasone Femoral head Methylprednisolone Osteonecrosis |
| title | Osteonecrosis of the femoral head in post-COVID-19 patients: a retrospective comparative study |
| title_full | Osteonecrosis of the femoral head in post-COVID-19 patients: a retrospective comparative study |
| title_fullStr | Osteonecrosis of the femoral head in post-COVID-19 patients: a retrospective comparative study |
| title_full_unstemmed | Osteonecrosis of the femoral head in post-COVID-19 patients: a retrospective comparative study |
| title_short | Osteonecrosis of the femoral head in post-COVID-19 patients: a retrospective comparative study |
| title_sort | osteonecrosis of the femoral head in post covid 19 patients a retrospective comparative study |
| topic | Avascular necrosis COVID-19 Dexamethasone Femoral head Methylprednisolone Osteonecrosis |
| url | https://doi.org/10.1186/s13018-025-05657-8 |
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