{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T02:04:35Z","timestamp":1783130675789,"version":"3.54.6"},"reference-count":60,"publisher":"Hamad bin Khalifa University Press (HBKU Press)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025]]},"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    The SARS-CoV-2 pandemic (COVID-19) has significantly impacted global health, with emerging evidence indicating potential long-term complications affecting various organ systems, including the musculoskeletal system, like avascular necrosis (AVN) of the femoral head. This retrospective study aims to investigate the incidence and risk factors of AVN in patients treated for COVID-19.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Methods:<\/jats:bold>\n                    We conducted a cross-sectional retrospective study in the department of orthopedics at a tertiary care teaching hospital in Central India from July 2022 to December 2023. Patients presenting with new-onset hip pain and low back pain who were asymptomatic before COVID-19 with a new radiological diagnosis of AVN hip were included in the study. Data on demographics, comorbidities, steroid use, and COVID-19 management were collected and analyzed using statistical tests to identify associations between these factors and AVN incidence.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results:<\/jats:bold>\n                    A total of 86 patients met the inclusion criteria. The majority of participants were males (83.7%), predominantly within the 30\u201345 years (44.2%) and 15\u201330 years (30.2%) age groups. Bilateral AVN was observed in 62.8% of cases. A significant portion (25.6%) had a history of COVID-19, with steroid use prevalent among 30.2% of participants, with an odds ratio of 4.47 indicating strong association. Statistically significant associations were found between COVID-19 status and age distribution (\n                    <jats:italic>p<\/jats:italic>\n                    = 0.049), comorbidities (\n                    <jats:italic>p<\/jats:italic>\n                    = 0.014), symptom onset (p = 0.001), and steroid therapy history (\n                    <jats:italic>p<\/jats:italic>\n                    = 0.002).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    This study highlights a notable incidence of AVN among COVID-19 patients, with significant correlations to steroid use and specific comorbidities. The findings underscore the importance of vigilant monitoring for AVN in post-COVID-19 patients, particularly those with a history of steroid therapy. Further research is needed to elucidate the mechanisms linking COVID-19 and AVN and to develop targeted prevention strategies.\n                  <\/jats:p>","DOI":"10.5339\/qmj.2025.38","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T01:30:42Z","timestamp":1751333442000},"source":"Crossref","is-referenced-by-count":1,"title":["The association of COVID-19 with the development of acute avascular necrosis of the head of the femur, apart from steroid usage"],"prefix":"10.5339","volume":"2025","author":[{"given":"Saurabh","family":"Sharma","sequence":"first","affiliation":[{"name":"Department of Orthopedics, Gandhi Medical College, Bhopal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akhil","family":"Bhansal","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Gandhi Medical College, Bhopal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rehan","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Gandhi Medical College, Bhopal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suresh","family":"Uikey","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Gandhi Medical College, Bhopal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonsi","family":"Tavethia","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, B.J Medical College, Ahmedabad, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9090-5151","authenticated-orcid":true,"given":"Anshul","family":"Bhadania","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, B.J Medical College, Ahmedabad, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shubh","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, B.J Medical College, Ahmedabad, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kinjal","family":"Solanki","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, B.J Medical College, Ahmedabad, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prahar","family":"Darji","sequence":"additional","affiliation":[{"name":"B.J. Medical College, Ahmedabad, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kavya","family":"Darji","sequence":"additional","affiliation":[{"name":"GCS Medical College & Research Center, Ahmedabad, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamal","family":"Sharma","sequence":"additional","affiliation":[{"name":"U N Mehta Institute of Cardiology and Research Centre, Ahmedabad, India*Correspondence: Anshul Bhadania anshulbhadania@gmail.com"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3277","reference":[{"key":"CIT0001","article-title":"Avascular necrosis","author":"Matthews\n \nAH","year":"2020"},{"issue":"(3):","key":"CIT0002","series-title":"Curr Rev Musculoskelet Med","first-page":"201\u20139","article-title":"Pathophysiology and risk factors for osteonecrosis","volume":"8","author":"Shah\n \nKN","year":"2015;"},{"key":"CIT0003","series-title":"eMedicine","article-title":"Femoral head avascular necrosis: practice 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\nOJ","year":"2020;"},{"key":"CIT0008","series-title":"J Clin Virol","first-page":"104370","article-title":"Prognostic value of interleukin-6, C-reactive protein, and procalcitonin in patients with COVID-19","volume":"127","author":"Liu\n \nF","year":"2020;"},{"issue":"(2):","key":"CIT0009","series-title":"N Engl J Med","first-page":"120\u20138","article-title":"Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in Covid-19","volume":"383","author":"Ackermann\n \nM","year":"2020;"},{"issue":"(3):","key":"CIT0010","series-title":"Curr Probl Cardiol","first-page":"100742","article-title":"Thrombosis and coagulopathy in COVID-19","volume":"46","author":"G\u00f3mez-Mesa\n \nJE","year":"2021;"},{"key":"CIT0011","series-title":"Ann Med Surg (Lond)","first-page":"104753","article-title":"Corticosteroids induced avascular necrosis of hip, a \u201clong COVID-19\u201d complication: case report","volume":"82","author":"Annam\n \nP","year":"2022;"},{"issue":"(5):","key":"CIT0012","series-title":"J Kedokteran Diponegoro (Diponegoro Med J)","first-page":"326\u20139","article-title":"Avascular necrosis","volume":"12","author":"Handayani\n \nM","year":"2023;"},{"issue":"(1):","key":"CIT0013","series-title":"Arch Public Health","first-page":"126\u201333","article-title":"Avascular necrosis of the femoral head in patient with Lyme disease and Devic\u2019s optic neuritis","volume":"15","author":"Velkovski\n \nV","year":"2023;"},{"issue":"(3):","key":"CIT0014","series-title":"Mol Med Rep","first-page":"3751\u20137","article-title":"Salidroside inhibits steroid-induced avascular necrosis of the femoral head via the PI3K\/Akt signaling pathway: in vitro and in vivo studies","volume":"17","author":"Xue\n \nX","year":"2017;"},{"issue":"(1):","key":"CIT0015","series-title":"BMC Musculoskelet Disord","first-page":"132","article-title":"Apoptosis associated with Wnt\/\u03b2-catenin pathway leads to steroid-induced avascular 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Int","first-page":"31\u20138","article-title":"Atraumatic femoral head necrosis in adults","volume":"113","author":"Arbab\n \nD","year":"2016;"},{"issue":"(5):","key":"CIT0024","series-title":"Ortop Traumatol Rehabil","first-page":"613\u20137","article-title":"Deceptive low back pain and pseudoradicular signs in avascular necrosis of the femoral head","volume":"6","author":"Modrzewski\n \nK","year":"2024;"},{"issue":"(8):","key":"CIT0025","series-title":"Medicina (Kaunas)","first-page":"1393","article-title":"Comorbidities of COVID-19 patients","volume":"59","author":"Silaghi-Dumitrescu\n \nR","year":"2023;"},{"key":"CIT0026","series-title":"Respir Med","first-page":"106096","article-title":"Underlying respiratory diseases, specifically COPD, and smoking are associated with severe COVID-19 outcomes: a systematic review and meta-analysis","volume":"171","author":"Sanchez-Ramirez\n \nDC","year":"2020;"},{"key":"CIT0027","series-title":"Front Psychiatry","first-page":"883306","article-title":"Alcohol use among young adults in Northern California during the COVID-19 pandemic\u2014an electronic health records-based study","volume":"13","author":"Metz\n \nVE","year":"2022;"},{"key":"CIT0028","series-title":"J Autoimmun","first-page":"102460","article-title":"The pathogenesis, diagnosis and clinical manifestations of steroid-induced osteonecrosis","volume":"110","author":"Chang\n \nC","year":"2020;"},{"issue":"(3):","key":"CIT0029","series-title":"Diagnostics (Basel)","first-page":"247","article-title":"A comprehensive review of COVID-19-infection- and steroid-treatment-associated bone avascular necrosis: a multi-study analysis","volume":"14","author":"Sakellariou\n \nE","year":"2024;"},{"issue":"(1):","key":"CIT0030","series-title":"J Orthop Rep","first-page":"100104","article-title":"A case series on Covid-19 infection and avascular necrosis of hip","volume":"2","author":"Jyothiprasanth\n \nM","year":"2023;"},{"key":"CIT0001","article-title":"Avascular necrosis","author":"Matthews\n \nAH","year":"2020"},{"issue":"(3):","key":"CIT0002","series-title":"Curr Rev Musculoskelet Med","first-page":"201\u20139","article-title":"Pathophysiology and risk factors for osteonecrosis","volume":"8","author":"Shah\n \nKN","year":"2015;"},{"key":"CIT0003","series-title":"eMedicine","article-title":"Femoral head avascular necrosis: practice essentials, etiology, epidemiology","year":"2023"},{"issue":"(12):","key":"CIT0004","series-title":"Medicina","first-page":"1311","article-title":"Avascular necrosis bone complication after active COVID-19 infection: preliminary results","volume":"57","author":"Sulewski\n \nA","year":"2021;"},{"issue":"(14):","key":"CIT0005","series-title":"J Bone Joint Surg","first-page":"1197\u2013204","article-title":"Musculoskeletal consequences of COVID-19","volume":"102","author":"Disser\n \nNP","year":"2020;"},{"issue":"(2):","key":"CIT0006","series-title":"J Sains Far Klin","first-page":"162","article-title":"Treatment of the cytokine storm in COVID-19: review of clinical pharmacology","volume":"10","author":"Sapriati\n \nAN","year":"2023;"},{"issue":"(6):","key":"CIT0007","series-title":"Am J Respir Crit Care Med","first-page":"812\u201321","article-title":"Characterization of the inflammatory response to severe COVID-19 illness","volume":"202","author":"McElvaney\n \nOJ","year":"2020;"},{"key":"CIT0008","series-title":"J Clin Virol","first-page":"104370","article-title":"Prognostic value of interleukin-6, C-reactive protein, and procalcitonin in patients with COVID-19","volume":"127","author":"Liu\n \nF","year":"2020;"},{"issue":"(2):","key":"CIT0009","series-title":"N Engl J Med","first-page":"120\u20138","article-title":"Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in Covid-19","volume":"383","author":"Ackermann\n \nM","year":"2020;"},{"issue":"(3):","key":"CIT0010","series-title":"Curr Probl Cardiol","first-page":"100742","article-title":"Thrombosis and coagulopathy in COVID-19","volume":"46","author":"G\u00f3mez-Mesa\n \nJE","year":"2021;"},{"key":"CIT0011","series-title":"Ann Med Surg (Lond)","first-page":"104753","article-title":"Corticosteroids induced avascular necrosis of hip, a \u201clong COVID-19\u201d complication: case report","volume":"82","author":"Annam\n \nP","year":"2022;"},{"issue":"(5):","key":"CIT0012","series-title":"J Kedokteran Diponegoro (Diponegoro Med J)","first-page":"326\u20139","article-title":"Avascular necrosis","volume":"12","author":"Handayani\n \nM","year":"2023;"},{"issue":"(1):","key":"CIT0013","series-title":"Arch Public Health","first-page":"126\u201333","article-title":"Avascular necrosis of the femoral head in patient with Lyme disease and Devic\u2019s optic neuritis","volume":"15","author":"Velkovski\n \nV","year":"2023;"},{"issue":"(3):","key":"CIT0014","series-title":"Mol Med Rep","first-page":"3751\u20137","article-title":"Salidroside inhibits steroid-induced avascular necrosis of the femoral head via the PI3K\/Akt signaling pathway: in vitro and in vivo studies","volume":"17","author":"Xue\n \nX","year":"2017;"},{"issue":"(1):","key":"CIT0015","series-title":"BMC Musculoskelet Disord","first-page":"132","article-title":"Apoptosis associated with Wnt\/\u03b2-catenin pathway leads to steroid-induced avascular necrosis of femoral head","volume":"16","author":"Zhang\n \nC","year":"2015;"},{"issue":"(3):","key":"CIT0016","series-title":"J Cell Mol Med","first-page":"2169\u201377","article-title":"Protective effect of Agrimonia pilosa polysaccharides on dexamethasone-treated MC3T3-E1 cells via Wnt\/\u03b2-Catenin pathway","volume":"24","author":"Huang\n \nW","year":"2020;"},{"key":"CIT0017","series-title":"Oxid Med Cell Longev","first-page":"9192413","article-title":"NADPH oxidase isoforms are involved in glucocorticoid-induced preosteoblast apoptosis","volume":"2019","author":"Bai\n \nSC","year":"2019;"},{"issue":"(6):","key":"CIT0018","series-title":"Exp Ther Med","first-page":"5047\u201352","article-title":"Epimedium protects steroid induced avascular necrosis of femoral head in rats by inhibiting autophagy","volume":"16","author":"Liu\n \nS","year":"2018;"},{"issue":"(6):","key":"CIT0019","series-title":"Ann Rheum Dis","first-page":"462\u20137","article-title":"Risk factors for avascular necrosis of bone in patients with systemic lupus erythematosus: is there a role for antiphospholipid antibodies?","volume":"59","author":"Mok\n \nMY","year":"2000;"},{"issue":"(2):","key":"CIT0020","series-title":"Indian J Orthop","first-page":"140\u20136","article-title":"Epidemiological profile of femoral head osteonecrosis in the North Indian population","volume":"52","author":"Vardhan\n \nH","year":"2018;"},{"issue":"(3):","key":"CIT0021","series-title":"Clin Radiol","first-page":"280\u20135","article-title":"Femoral head avascular 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