Unrestricted consumption of steroids by Covid patients during the pandemic has led to a sharp increase in cases of avascular necrosis of hip (AVN) affecting the hip joint, with even young people in their 20s reporting to the hospital with complaints of hip and thigh pain and difficulty walking. There is a 20-30% spike in cases of avascular necrosis of the hip, also called osteonecrosis, in the post-pandemic period. Orthopaedics said that one out of every five patients coming to us with problems of the hip has a history of taking steroids for Covid treatment. Many have abused steroids without a prescription.
Senior orthopaedic from JJ hospital, said due to the delay in reporting they have seen a rise in such cases from rural parts of Maharashtra in the last three months with pandemic curbs being lifted. However, one of the factors which led to a rise in Avascular Necrosis post covid recovery is the excessive use of life-saving corticosteroids during the first and second wave. “We earlier operated on eight cases a month and saw 10-15 patients with a hip problem in each outdoor patient department (OPD). We are now operating twenty cases a month and seeing 25-30 cases per OPD in the last two or three months,” he said.
He further said that more than 50 per cent of these cases have had a Covid-19 history along with hospitalisation in the past. “While taking the clinical history, we found that 50% of these patients had Covid-19 in the second wave and were hospitalized. Their symptoms like pain in the groin, thigh or buttock region and stiffness in joints within months of getting discharged,” the doctor added.
One of the members of COVID-19 TaskForce, Maharashtra said Covid-19 causes hypercoagulation- a condition that causes the blood to clot more easily than normal. “It is one of the causes that led to AVN. In some cases, Covid-19 aggravated the already existing mild form of AVN. Steroid usage too increased in AVN cases in Covid-19 recovered patients. “We need to focus on post covid complications as there are many and AVN is one of the major complications which is seen in covid recovered patients. Most of these cases are delayed in treatment,” he said.
Dr Mrinal Sharma, Head of Department of Orthopaedics, Amrita hospital said the incidence of avascular necrosis of the hip is high among steroid takers. There is no known cause in 60-70 per cent of AVN cases, while the rest are caused by factors like excessive drinking or taking steroids, such as by gym goers or patients with diseases like rheumatoid arthritis or lung problems. Sometimes, quacks also mix steroids in their medicines to offer quick relief without informing patients. Steroid abuse has been seen in people who were on acute or long-term treatment for Covid.
“Many of them took steroids indiscriminately without any dosage control or supervision by doctor, by buying these directly from pharmacists. This has caused a surge of 20-30 per cent in cases of avascular necrosis of the hip in the post-Covid period. We are seeing many such cases of hip destruction even in the younger age group of 20-30 years. I know of a 21-year-old patient who had to undergo a hip transplant due to the after-effects of rampant use of steroids during the pandemic,” he said.
The use of corticosteroids (especially at high doses) even for a few months or years is associated with potentially serious adverse events. Their use is a common cause of avascular necrosis of the hip, a condition that involves the death of bone tissue due to reduced blood supply. Bone death eventually leads to collapse, sometimes only in a matter of months. The hip ball gets deformed into a mushroom shape and cannot bear the load of the body. This results in arthritis of the hip joint, with symptoms like pain in the hip and inner thighs, stiffness, and inability to walk. How steroids lead to AVN is not clearly understood but some believe that corticosteroids can increase levels of lipid (fatty acid) in the blood, reducing blood flow to the bones.
