Enejd Veizi, Yasin Erdoğan, Başak Sinem Sezgin, Yavuz Karaman, Kasım Kılıçarslan, Ahmet Fırat

Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Türkiye

Keywords: Corticosteroids, COVID, hip, knee, osteonecrosis.


Objectives: This study aims to evaluate the incidence of osteonecrosis (ONC), with a special focus on ONC of the femoral head (ONFH), in novel coronavirus disease 2019 (COVID-19) patients two years after the pandemic.

Patients and methods: This prospective study included COVID-19 patients who were admitted to our center between March 2020 and June 2020. A total of 472 patients (289 males, 183 females; mean age: 42.3±12.0 years; range, 18 to 60 years) were arranged in a list according to their date and time of admission and, then, divided into two groups: those not receiving corticosteroid (CS) treatment (Group 1, n=236) and those receiving CS treatment (Group 2, n=236). The patients were evaluated for joint pain based on X-rays and magnetic resonance imaging scans, and the patients were routinely followed. For each patient in Group 2, additional data regarding CS use were recorded. The possible relationship between ONC and risk factors was analyzed.

Results: Both groups were similar in terms of age and sex. Group 2 had a significantly longer hospitalization period. A significant increase in the number of painful joints was observed in Group 2. At two years, 5.1% of the patients in Group 1 complained of at least one painful joint compared to 11.9% of patients in Group 2. Eight patients from Group 2 developed ONC.

Conclusion: The incidence of ONC after CS therapy in COVID-19 patients is on the rise. At two years, 5% of patients receiving various doses of CSs may develop ONC. Residual joint pain is common even after recovering from the virus. No relationship is evident between the duration of treatment, cumulative dosage of medication, maximum one-day dosage received, and the presence of ONC.

Citation: Veizi E, Erdoğan Y, Sezgin BS, Karaman Y, Kılıçarslan K, Fırat A. The painful joint after COVID-19 treatment: A study on joint osteonecrosis following COVID-19-related corticosteroid use. Jt Dis Relat Surg 2023;34(1):75-83. doi: 10.52312/jdrs.2023.895

Ethics Committee Approval

The study protocol was approved by the Ankara City Hospital Clinical Research Ethics Committee (date: 20.01.2021, no: E1/1429/2020). The study was conducted in accordance with the principles of the Declaration of Helsinki.

Author Contributions

Idea/concept, analysis and/or interpretation, critical review, materials: A.F., E.V.; Design, literature review: Y.E., K.K.; Control/supervision: A.F., K.K.; Data collection and/or processing, writing the article, references and fundings: B.S.S., Y.K.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.