Screening for Femoral Head Osteonecrosis Following COVID-19: Is It Worth It?

Objectives

Based on WHO data, as of June 2022, there were 532.2 million confirmed COVID-19 cases globally. In the initial phase of the COVID -19 pandemic, patients experiencing critical illness marked by severe respiratory distress were commonly subjected to corticosteroid treatment. Regrettably, the administration of exogenous corticosteroids stands as the prevailing cause of ONFH. In the current narrative review, we aim to evaluate if active screening should be utilized to diagnose post-COVID-19 ONFH in its early stages.

Methods

The databases for PubMed, CINAHL, and Science Direct were systematically queried in March 2022. The search terms were as follows: "COVID-19", "severe acute respiratory syndrome", "coronavirus", "systemic steroid", "corticosteroid", "femoral head osteonecrosis", "avascular necrosis", or "steroid therapy." The included studies for review were all required to be peer-reviewed studies in the English language with Reported complications linked to steroid therapy in COVID-19 patients or potential connections to the development of ONFH in individuals recovering from the novel coronavirus have been documented.

Results

Systemic corticosteroids were frequently employed in managing critically ill COVID-19 patients. The CDC reports up to June 2022 showed more than 4.8 million COVID-19 hospitalizations in the US, with approximately over one million patients receiving steroids. In a study of ONFH after infection with COVID-19, all patients had bilateral involvement. The average duration from the initiation of corticosteroid treatment to the onset of symptoms was 132.8 days.

Conclusion

In summary, a distinct correlation exists between the administration of steroids to individuals with COVID-19 and the subsequent risk of ONFH. Moreover, an elevated dosage and prolonged duration of steroid therapy in COVID-19 patients are associated with an increased likelihood of developing ONFH. Therefore, active screening for high-risk patients, that may have received systemic corticosteroid treatment during a COVID-19 illness, may be reasonable.

Influencing factors on the functional level of haemophilic patients assessed by FISH

Joint destruction in early adulthood brings the patients to the orthopaedic clinics. If a haemophilic patient becomes disabled, it shows a number of factors such as timely diagnosis, availability of appropriate treatment depending on the country, access and affordability to treatments and equally importantly the responsibility of the patient in managing self care by remaining compliant by prescribed treatment regimen. We assessed the functional level by functional independence score in haemophilia (FISH). Overall, 104 patients with haemophilia A and 29 with haemophilia B were evaluated. We assessed the function of the patients by FISH. We divided the sum scores into weak (FISH score 8-16), moderate (17-24), and good (25-32). For evaluating the level of functional deficit in a 2 × 2 table, we categorized the weak and moderate levels into Disordered Group and the good level into Not-Disordered Group. The average age was 26.9 ± 14.24. Each 1 year increase in age can increase 1.07 fold the possibility of being placed in Disordered Function Group. Severe haemophilia can increase 7.34 fold, presence of inhibitor can increase 9.75 fold and home self-care increases 3.89 fold the possibility of being placed in Disordered Function Group. To decrease the burden of the cost on patient, family and the government, education plays the most important role. We suggest that we send a trained team of physician and nurses to the deprived villages and cities instead of waiting for the patient to refer to our Care Center.