{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T14:22:02Z","timestamp":1789050122232,"version":"build-2803163510"},"reference-count":71,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Fondazione FROM"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Objectives: The association between osteonecrosis (ON) and Coronavirus Disease of 2019 (COVID-19) was reported early during the pandemic. ON of the femoral head (ONFH) is particularly problematic, as it may destroy the joint and lead to arthroplasty, although early diagnosis and treatment might mitigate its progression. The aim of the present study was to quantify the prevalence of symptomatic and asymptomatic ONFH in patients with severe COVID-19 treated with high doses of corticosteroids during the first pandemic wave. Methods: For this prospective, observational, monocentric cohort study, patients were selected according to the risk factors described for severe acute respiratory syndrome coronavirus in 2002\u20132004 (SARS-1): young males (&lt;61 years old), high cumulative cortisone doses (\u22652 g), severe disease, and followed up clinically and with magnetic resonance imaging. ONFH was classified with the ARCO classification. Results: Out of 1944 patients admitted for COVID-19 from 23 February to 21 May 2020, 856 of 1944 were treated in ICU; 30\/1944 were selected according to the inclusion criteria and 27 of 30 were enrolled. The mean age at admission was 54 years (range, 42\u201360). The mean dose of cumulative cortisone was 6.25 g (range, 2\u201316). A total of 4\/27 (15%) patients had ONFH; only 2 of 4 (50%) were symptomatic, including 1 with multiple ON of major joints. Conclusions: A high-risk cohort of patients with COVID-19 and high doses of corticosteroids had a 15% rate of ONFH, and 2 years after the event, 50% of them were asymptomatic. For those patients, relying solely on clinical evaluation would risk underestimating ONFH, potentially influencing treatment and outcomes. Moreover, other joints might develop ON. The data collected in the present study can be considered for the management of long-COVID. The association between severe COVID-19, high doses of corticosteroids and ONFH suggests the need for focused clinical and magnetic resonance imaging, considering the high rate of asymptomatic patients.<\/jats:p>","DOI":"10.3390\/diagnostics16101466","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T12:33:37Z","timestamp":1778589217000},"page":"1466","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prevalence of Osteonecrosis of the Femoral Head in High-Risk Male Patients with Severe COVID-19 Treated with High-Dose Corticosteroids: A Prospective Cohort Study Using Screening MRI-How Many Have Been Left Behind?"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8237-6738","authenticated-orcid":false,"given":"Nicola","family":"Guindani","sequence":"first","affiliation":[{"name":"Orthopaedics and Traumatology Unit, Regional Health Care and Social Agency Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy"},{"name":"School of Medicine and Surgery, University of Milano\u2013Bicocca, Piazza dell\u2019Ateneo Nuovo 1, 20126 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1352-4093","authenticated-orcid":false,"given":"Mario","family":"Gaffuri","sequence":"additional","affiliation":[{"name":"Orthopaedics and Traumatology, Moncucco Clinic, via Soldino 5, 6900 Lugano, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5335-9429","authenticated-orcid":false,"given":"Pietro Andrea","family":"Bonaffini","sequence":"additional","affiliation":[{"name":"School of Medicine and Surgery, University of Milano\u2013Bicocca, Piazza dell\u2019Ateneo Nuovo 1, 20126 Milano, Italy"},{"name":"Department of Radiology, Regional Health Care and Social Agency Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clarissa","family":"Valle","sequence":"additional","affiliation":[{"name":"School of Medicine and Surgery, University of Milano\u2013Bicocca, Piazza dell\u2019Ateneo Nuovo 1, 20126 Milano, Italy"},{"name":"Department of Radiology, Regional Health Care and Social Agency Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Caruso","sequence":"additional","affiliation":[{"name":"School of Medicine and Surgery, University of Milano\u2013Bicocca, Piazza dell\u2019Ateneo Nuovo 1, 20126 Milano, Italy"},{"name":"Department of Radiology, Regional Health Care and Social Agency Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greta","family":"Carioli","sequence":"additional","affiliation":[{"name":"FROM Research Foundation\u2013ETS, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Fenili","sequence":"additional","affiliation":[{"name":"FROM Research Foundation\u2013ETS, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4425-7866","authenticated-orcid":false,"given":"Rosalia","family":"Zangari","sequence":"additional","affiliation":[{"name":"FROM Research Foundation\u2013ETS, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandro","family":"Sironi","sequence":"additional","affiliation":[{"name":"School of Medicine and Surgery, University of Milano\u2013Bicocca, Piazza dell\u2019Ateneo Nuovo 1, 20126 Milano, Italy"},{"name":"Department of Radiology, Regional Health Care and Social Agency Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Chiodini","sequence":"additional","affiliation":[{"name":"Orthopaedics and Traumatology Unit, Regional Health Care and Social Agency Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio Carlo","family":"Castelli","sequence":"additional","affiliation":[{"name":"Orthopaedics and Traumatology Unit, Regional Health Care and Social Agency Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy"},{"name":"FROM Research Foundation\u2013ETS, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2084","DOI":"10.1002\/jbmr.4144","article-title":"Reply to Corticosteroid-Induced Osteonecrosis in COVID-19: A Call for Caution","volume":"35","author":"Yu","year":"2020","journal-title":"J. Bone Miner. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.2106\/JBJS.20.00847","article-title":"Musculoskeletal Consequences of COVID-19","volume":"102","author":"Disser","year":"2020","journal-title":"J. Bone Jt. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1763","DOI":"10.1007\/s00256-021-03734-7","article-title":"Musculoskeletal involvement of COVID-19: Review of imaging","volume":"50","author":"Ramani","year":"2021","journal-title":"Skelet. Radiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1595","DOI":"10.1007\/s00198-020-05487-w","article-title":"What can we learn about corticosteroid therapy as a treatment for COVID-19?","volume":"31","author":"Tang","year":"2020","journal-title":"Osteoporos. Int."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e940965-1\u2013e940965-6","DOI":"10.12659\/MSM.940965","article-title":"Corticosteroid-Associated Avascular Necrosis of the Femoral Head in Patients with Severe COVID-19: A Single-Center Study","volume":"29","author":"Velchov","year":"2023","journal-title":"Med. Sci. Monit."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3387","DOI":"10.1002\/art.20517","article-title":"Combined effects of an anticoagulant and a lipid-lowering agent on the prevention of steroid-induced osteonecrosis in rabbits","volume":"50","author":"Motomura","year":"2004","journal-title":"Arthritis Rheum."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1016\/j.prp.2004.10.003","article-title":"Bone marrow fat-cell enlargement in early steroid-induced osteonecrosis\u2014A histomorphometric study of autopsy cases","volume":"200","author":"Motomura","year":"2005","journal-title":"Pathol. Res. Pract."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1302\/2058-5241.4.180036","article-title":"Osteonecrosis of the femoral head: Pathophysiology and current concepts of treatment","volume":"4","author":"Petek","year":"2019","journal-title":"EFORT Open Rev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.ocl.2018.10.001","article-title":"Osteonecrosis of the Femoral Head","volume":"50","author":"Cui","year":"2019","journal-title":"Orthop. Clin. N. Am."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e65","DOI":"10.3346\/jkms.2021.36.e65","article-title":"ARCO Consensus on the Pathogenesis of Non-traumatic Osteonecrosis of the Femoral Head","volume":"36","author":"Cui","year":"2021","journal-title":"J. Korean Med. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1007\/s00198-016-3824-z","article-title":"Steroid therapy and the risk of osteonecrosis in SARS patients: A dose-response meta-analysis","volume":"28","author":"Zhao","year":"2017","journal-title":"Osteoporos. Int."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2342","DOI":"10.1016\/j.arth.2020.04.092","article-title":"Diagnosis of Osteonecrosis of the Femoral Head: Too Little, Too Late, and Independent of Etiology","volume":"35","author":"Boontanapibul","year":"2020","journal-title":"J. Arthroplast."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1007\/s00132-018-3615-7","article-title":"Imaging and classification of avascular femoral head necrosis","volume":"47","author":"Bohndorf","year":"2018","journal-title":"Orthopade"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1016\/j.arth.2019.11.029","article-title":"The 2019 Revised Version of Association Research Circulation Osseous Staging System of Osteonecrosis of the Femoral Head","volume":"35","author":"Yoon","year":"2020","journal-title":"J. Arthroplast."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.arth.2018.09.005","article-title":"Etiologic Classification Criteria of ARCO on Femoral Head Osteonecrosis Part 1: Glucocorticoid-Associated Osteonecrosis","volume":"34","author":"Yoon","year":"2019","journal-title":"J. Arthroplast."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1177\/11207000241233906","article-title":"MRI spectrum of avascular necrosis of femoral head in patients treated for COVID-19","volume":"34","author":"He","year":"2024","journal-title":"HIP Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1203\/01.PDR.0000129184.87042.FC","article-title":"SARS: The first pandemic of the 21st century","volume":"56","author":"Cherry","year":"2004","journal-title":"Pediatr. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1551","DOI":"10.1007\/s00264-018-3907-x","article-title":"Combined pharmacotherapy for osteonecrosis of the femoral head after severe acute respiratory syndrome and interstitial pneumonia: Two and a half to fourteen year follow-up","volume":"42","author":"Wang","year":"2018","journal-title":"Int. Orthop."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1302\/0301-620X.96B2.31935","article-title":"The influence of age, gender and treatment with steroids on the incidence of osteonecrosis of the femoral head during the management of severe acute respiratory syndrome: A retrospective study","volume":"96","author":"Guo","year":"2014","journal-title":"Bone Jt. J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1007\/s00296-023-05332-3","article-title":"Osteonecrosis amid the COVID-19 pandemic","volume":"43","author":"Baimukhamedov","year":"2023","journal-title":"Rheumatol. Int."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1007\/s00264-023-06028-w","article-title":"Is COVID-19 an independent risk factor for the development of avascular necrosis of the hip? A retrospective study to evaluate the factors associated with avascular necrosis of the hip in patients who had COVID-19 infection","volume":"48","author":"Sehrawat","year":"2024","journal-title":"Int. Orthop."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s12306-024-00854-w","article-title":"Osteonecrosis as a manifestation of Long-COVID Syndrome: A systematic review","volume":"109","author":"Za","year":"2024","journal-title":"Musculoskelet. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Perico, N., Fagiuoli, S., Di Marco, F., Laghi, A., Cosentini, R., Rizzi, M., Gianatti, A., Rambaldi, A., Ruggenenti, P., and La Vecchia, C. (2021). Bergamo and Covid-19: How the Dark Can Turn to Light. Front. Med., 8.","DOI":"10.3389\/fmed.2021.609440"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.2147\/TCRM.S140694","article-title":"A12-year follow-up study of combined treatment of post-severe acute respiratory syndrome patients with femoral head necrosis","volume":"13","author":"Liu","year":"2017","journal-title":"Ther. Clin. Risk Manag."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Aprato, A., Guindani, N., Mass\u00e8, A., Castelli, C.C., Cipolla, A., Antognazza, D., Benazzo, F., Bove, F., Casiraghi, A., and Catani, F. (2021). Clinical activities, contaminations of surgeons and cooperation with health authorities in 14 orthopedic departments in north Italy during the most acute phase of covid-19 pandemic. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18105340"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"109092","DOI":"10.1016\/j.ejrad.2020.109092","article-title":"Diagnostic impact of bedside chest X-ray features of 2019 novel coronavirus in the routine admission at the emergency department: Case series from Lombardy region","volume":"129","author":"Ippolito","year":"2020","journal-title":"Eur. J. Radiol."},{"key":"ref_27","unstructured":"Brunton, L. (2006). Goodman & Gilman\u2019 s The Pharmacological Basis of Therapeutics, McGraw-Hill Education. Chapter 59, Table 59-2."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1055\/s-0031-1293500","article-title":"Musculoskeletal complications of severe acute respiratory syndrome","volume":"15","author":"Griffith","year":"2011","journal-title":"Semin. Musculoskelet. Radiol."},{"key":"ref_29","first-page":"155","article-title":"EuroQol-5D (EQ-5D): An instrument for measuring quality of life","volume":"78","author":"Balestroni","year":"2012","journal-title":"Monaldi Arch. Chest Dis.-Card. Ser."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1007\/s11136-010-9811-5","article-title":"Cross-cultural adaptation and validation with reliability, validity, and responsiveness of the Italian version of the Oxford Hip Score in patients with hip osteoarthritis","volume":"20","author":"Martinelli","year":"2011","journal-title":"Qual. Life Res."},{"key":"ref_31","unstructured":"Riffenburgh, R., and Gillen, D. (2020). Statistics in Medicine, Elsevier. [4th ed.]."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"590","DOI":"10.5312\/wjo.v6.i8.590","article-title":"Current concepts on osteonecrosis of the femoral head","volume":"6","author":"Gianakos","year":"2015","journal-title":"World J. Orthop."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1007\/s00264-020-04790-9","article-title":"What are the outcomes of core decompression without augmentation in patients with nontraumatic osteonecrosis of the femoral head?","volume":"45","author":"Andronic","year":"2021","journal-title":"Int. Orthop."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1016\/j.jos.2017.12.004","article-title":"Effectiveness of various hip preservation treatments for non-traumatic osteonecrosis of the femoral head: A network meta-analysis of randomized controlled trials","volume":"23","author":"Yu","year":"2018","journal-title":"J. Orthop. Sci."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"152001","DOI":"10.1016\/j.imbio.2020.152001","article-title":"Endothelial injury and thrombotic microangiopathy in COVID-19: Treatment with the lectin-pathway inhibitor narsoplimab","volume":"225","author":"Rambaldi","year":"2020","journal-title":"Immunobiology"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1097\/BPO.0000000000000779","article-title":"Restoration of Blood Flow to the Proximal Femoral Epiphysis in Unstable Slipped Capital Femoral Epiphysis by Modified Dunn Procedure: A Preliminary Angiographic and Intracranial Pressure Monitoring Study","volume":"38","author":"Jackson","year":"2018","journal-title":"J. Pediatr. Orthop."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1093\/mr\/road095","article-title":"Magnetic resonance imaging screening for osteonecrosis of the femoral head after coronavirus disease 2019","volume":"34","author":"Takashima","year":"2024","journal-title":"Mod. Rheumatol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1007\/s00198-009-1003-1","article-title":"The epidemiology of osteonecrosis: Findings from the GPRD and THIN databases in the UK","volume":"21","author":"Cooper","year":"2010","journal-title":"Osteoporos. Int."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e020680","DOI":"10.1136\/bmjopen-2017-020680","article-title":"Association of common comorbidities with osteonecrosis: A nationwide population-based case-control study in Denmark","volume":"8","author":"Dima","year":"2018","journal-title":"BMJ Open"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1506","DOI":"10.1016\/j.arth.2015.03.036","article-title":"High-Dose Corticosteroid Use and Risk of Hip Osteonecrosis: Meta-Analysis and Systematic Literature Review","volume":"30","author":"Mont","year":"2015","journal-title":"J. Arthroplast."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Muthu, S., Jeyaraman, M., Selvaraj, P., Jeyaraman, N., Potty, A.G., and Gupta, A. (2023). Dose\u2013Response Meta-Analysis of Corticosteroid Effects in SARS Outbreak: A Model for Risk Stratification and Screening Strategy for Osteonecrosis of Femoral Head Post-Corticosteroid Therapy for COVID-19. Life, 13.","DOI":"10.3390\/life13040907"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1016\/S0140-6736(87)92870-4","article-title":"Across-Study Evaluation of Association Between Steroid Dose and Bolus Steroids and Avascular Necrosis of Bone","volume":"329","author":"Felson","year":"1987","journal-title":"Lancet"},{"key":"ref_43","first-page":"761","article-title":"Predictive factors for symptomatic osteonecrosis in patients with systemic lupus erythematosus","volume":"28","author":"Gladman","year":"2001","journal-title":"J. Rheumatol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1177\/096120339200100610","article-title":"High-dose intravenous methylprednisolone therapy associated with osteonecrosis in patients with systemic lupus erythematosus","volume":"1","author":"Massardo","year":"1992","journal-title":"Lupus"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1007\/s00264-018-4018-4","article-title":"Classification systems of hip osteonecrosis: An updated review","volume":"43","author":"Sultan","year":"2019","journal-title":"Int. Orthop."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.arth.2018.09.006","article-title":"Etiologic Classification Criteria of ARCO on Femoral Head Osteonecrosis Part 2: Alcohol-Associated Osteonecrosis","volume":"34","author":"Yoon","year":"2019","journal-title":"J. Arthroplast."},{"key":"ref_47","unstructured":"Vigorita, V.J., Ghelman, B., and Mintz, D. (2016). Orthopaedic Pathology, Lippincott Williams & Wilkins. [3rd ed.]. Available online: https:\/\/pathology.lwwhealthlibrary.com\/book.aspx?bookid=2631&sectionid=0."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1016\/S1297-319X(02)00391-3","article-title":"Intraosseous circulation from physiology to disease","volume":"69","author":"Laroche","year":"2002","journal-title":"Jt. Bone Spine"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Konarski, W., Pobo\u017cy, T., \u015aliwczy\u0144ski, A., Kotela, I., Krakowiak, J., Hordowicz, M., and Kotela, A. (2022). Avascular Necrosis of Femoral Head\u2014Overview and Current State of the Art. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19127348"},{"key":"ref_50","first-page":"6","article-title":"Atraumatic osteonecrosis of the humeral head","volume":"1","author":"Gruson","year":"2009","journal-title":"Bull. NYU Hosp. Jt. Dis."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Koo, K., Mont, M., and Jones, L. (2014). Glucocorticoids (as an Etiologic Factor). Osteonecrosis, Springer.","DOI":"10.1007\/978-3-642-35767-1"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1354\/vp.40-4-345","article-title":"Osteonecrosis of the femoral head of laboratory animals: The lessons learned from a comparative study of osteonecrosis in man and experimental animals","volume":"40","author":"Boss","year":"2003","journal-title":"Vet. Pathol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"266","DOI":"10.3109\/17453674.2014.916490","article-title":"Corticosteroid administration within 2 weeks after renal transplantation affects the incidence of femoral head osteonecrosis","volume":"85","author":"Saito","year":"2014","journal-title":"Acta Orthop."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1007\/s00264-013-1775-y","article-title":"The natural history of asymptomatic osteonecrosis of the femoral head","volume":"37","author":"Kang","year":"2013","journal-title":"Int. Orthop."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"2165","DOI":"10.2106\/JBJS.I.00575","article-title":"The natural history of untreated asymptomatic osteonecrosis of the femoral head: A systematic literature review","volume":"92","author":"Mont","year":"2010","journal-title":"J. Bone Jt. Surg."},{"key":"ref_56","first-page":"e10047","article-title":"What\u2019s the Risk: Differentiating Risk Ratios, Odds Ratios, and Hazard Ratios?","volume":"12","author":"George","year":"2020","journal-title":"Cureus"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"75","DOI":"10.52312\/jdrs.2023.895","article-title":"The painful joint after COVID-19 treatment: A study on joint osteonecrosis following COVID-19-related corticosteroid use","volume":"34","author":"Veizi","year":"2022","journal-title":"Jt. Dis. Relat. Surg."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.ejim.2024.01.006","article-title":"Osteonecrosis risk after steroids-related treatment of COVID-19 is not negligible: A cross sectional study","volume":"123","author":"Koutalos","year":"2024","journal-title":"Eur. J. Intern. Med."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1097\/00003086-199204000-00008","article-title":"Experimental steroid-induced osteonecrosis in adult rabbits with hypersensitivity vasculitis","volume":"277","author":"Matsui","year":"1992","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1016\/8756-3282(96)00078-6","article-title":"Inducible osteonecrosis in a rabbit serum sickness model: Deposition of immune complexes in bone marrow","volume":"18","author":"Nakata","year":"1996","journal-title":"Bone"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1038\/s41590-020-00832-x","article-title":"Macrophage expression and prognostic significance of the long pentraxin PTX3 in COVID-19","volume":"22","author":"Brunetta","year":"2021","journal-title":"Nat. Immunol."},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Kuliyeva, A., Serejnikova, N., Eshmotova, G., Teslya, Y., Ivina, A., Zarov, A., Panin, M., Prizov, A., Lyalina, V., and Shestakov, D. (2025). Post-COVID-19 Femoral Head Osteonecrosis Exhibits Mast Cell Clusters, Fibrosis, and Vascular Thrombosis: Key Pathological Mechanisms in Long COVID-19 Bone Degeneration. Pathophysiology, 32.","DOI":"10.3390\/pathophysiology32030036"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/j.thromres.2020.06.042","article-title":"The pathogenesis of thromboembolic disease in COVID-19 patients: Could be a catastrophic antiphospholipid syndrome?","volume":"194","author":"Previtali","year":"2020","journal-title":"Thromb. Res."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1161\/CIRCULATIONAHA.120.051828","article-title":"Microthrombi as a Major Cause of Cardiac Injury in COVID-19 A Pathologic Study","volume":"143","author":"Pellegrini","year":"2021","journal-title":"Circulation"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"S2","DOI":"10.1016\/j.arth.2025.06.052","article-title":"Characteristics of Osteonecrosis of the Femoral Head After COVID-19 Compared to Corticosteroid-Associated Osteonecrosis of the Femoral Head: AMulticenter Large Database Study in Japan","volume":"40","author":"Imagama","year":"2025","journal-title":"J. Arthroplast."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1002\/(SICI)1097-0258(19980115)17:1<101::AID-SIM727>3.0.CO;2-E","article-title":"Sample size and optimal designs for reliability studies","volume":"17","author":"Walter","year":"1998","journal-title":"Stat. Med."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1007\/s00011-022-01616-9","article-title":"Long-term implications of COVID-19 on bone health: Pathophysiology and therapeutics","volume":"71","author":"Sapra","year":"2022","journal-title":"Inflamm. Res."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Raimondi, F., Novelli, L., Ghirardi, A., Russo, F.M., Pellegrini, D., Biza, R., Trapasso, R., Giuliani, L., Anelli, M., and Amoroso, M. (2021). COVID-19 and gender: Lower rate but same mortality of severe disease in women\u2014An observational study. BMC Pulm. Med., 21.","DOI":"10.1183\/13993003.congress-2021.PA3663"},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Du, M., Ma, Y., Deng, J., Liu, M., and Liu, J. (2022). Comparison of Long COVID-19 Caused by Different SARS-CoV-2 Strains: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph192316010"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1038\/s41591-020-01202-8","article-title":"Immune determinants of COVID-19 disease presentation and severity","volume":"27","author":"Brodin","year":"2021","journal-title":"Nat. Med."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1111\/imr.13089","article-title":"Immunological memory to SARS-CoV-2 infection and COVID-19 vaccines","volume":"310","author":"Sette","year":"2022","journal-title":"Immunol. Rev."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/10\/1466\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T13:09:41Z","timestamp":1778591381000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/10\/1466"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,12]]},"references-count":71,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["diagnostics16101466"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16101466","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,12]]}}}