Explained: Avascular necrosis (AVN), the new post-Covid-19 complication; causes, symptoms, treatment

The second wave of Covid19 in India was beyond brutal Apart from the rise in number of deaths due to coronavirus there was also an increase in the complications noted in recovered coronavirus patients mdash including the damaging mucormycosis or black fungus Now according to latest reports avascular necrosis AVN or osteonecrosis can also be a cause of concern postCovid Recently at least three cases of AVN were reported in MumbaiTo know more about the disease and its connection with Covid19 Middaycom spoke to Dr Niraj Kasat consultant joint replacement surgeon Wockhardt Hospital Mira Road and Dr Mayank Vijayvargiya junior consultant joint replacement and preservation surgeon department of orthopaedics PD Hinduja HospitalDr Niraj Kasat left and Dr Mayank VijayvargiyaWhat is avascular necrosis Why is it referred to as lsquobone deathrsquoKasat Avascular necrosis also known as osteonecrosis leads to the death of onersquos bone tissue because of the poor blood supply It causes tiny breaks in onersquos bone and the bone tends to collapse A broken bone or even a dislocated joint tends to stop the blood flow to a section of bone There is temporary or permanent loss of blood supply to the bone the bone tissues die and that is why it is referred to as bone death It is a worrisome degenerative bone condition seen in people nowadays This condition can be seen in any bone and is commonly seen at the end of a long bone It impacts one bone several bones at one time or even different bones at different timesVijayvargiya Avascular necrosis of the bone occurs when the blood supply to the bone is compromised and when the blood supply is cut off the bone dies That section of the bone much like the heart or the brain dies A heart attack occurs when anything happens to the heart A stroke occurs in the brain When avascular necrosis happens the section of the bone that no longer receives blood enters a phase in which that sector region receives no blood Since it is a bone with a lot of structure surrounding it it does not always collapse right away but it does cause discomfort Now youre experiencing pain in that area which the patient may mistakenly attribute to a sprain or injury In general it is not necessary that every incident of bone pain is AVN We do know however that this can occur in the hipWhat are the causes of avascular necrosisKasat A fracture longterm use of corticosteroids damage to the blood vessels injury chronic medical conditions and alcohol can lead to this condition Vijayvargiya When a person experiences discomfort in the hip and is unable to move he or she should seek the opinion of an orthopaedic specialist The best person to determine whether this is AVN or another pathology is an orthopaedic surgeonWhat are the symptoms of avascular necrosisKasat If you have avascular necrosis then you will exhibit symptoms such as joint pain limited range of motion owing to the joint pain and the bone and joint will even collapse Once you notice any of these symptoms you need to consult a doctor immediately and get treated as early as possibleIs there a connection between Covid19 and avascular necrosisKasat The second wave of Covid19 in India caused complications in recovered coronavirus patients like mucormycosis blood clots newonset diabetes and chronic fatigue among others The latest is avascular necrosis or osteonecrosis that is haunting patients now AVN is postCovid sequelae Like other postCovid ailments avascular necrosis of the femoral head in the bone and jointsegment has become a common occurrence because of steroids used in the treatment of Covid19 Excessive and prolonged use of steroids to tackle Covid19 may suppress natural immunity when used for patients with low oxygen levels Many patients using steroids have suffered from AVN Pain associated with avascular necrosis of the hip might also be felt around the areas like the groin region thigh or buttock Besides the hip it may also affect the shoulder knee hand and foot So donrsquot ignore joint pain at any costVijayvargiya AVN has been linked to certain doses of steroids in the literature studies This has been observed in Covid19 individuals who were given half of the normal steroid dose However we now have a case for which we know the patient was diagnosed with Covid19 almost two months before the diagnosis of AVN and we know that steroid was given as a lifesaving medicine Wersquore not saying that steroids shouldnrsquot be used but they can cause a reaction in the body resulting in AVN of the hip An MRI can easily identify those patients if there is some clinical suspicion If that is discovered medical treatment is possible unlike many of the ailments that Covid19 is responsible forA few cases of avascular necrosis have been reported in Mumbai and Delhi Is it a cause of concern as a postCovid complicationKasat After mucormycosis AVN is one of the most worrisome conditions that postCovid patients are suffering from It is rampant in patients and needs immediate medical attention Not treating it promptly can be dangerous for the patients If you are recovering from Covid and have a history of steroid use then get yourself evaluated by a bone and joint specialist Approximately a patient who has recovered from Covid may experience AVN symptoms after 34 months and may need medical helpVijayvargiya The first three patients who were diagnosed with AVN symptoms were all doctors They were well aware of the condition and that the hip joint pain was unusual They did not delay or ignore the problem As these experts were already aware of the case studies for the last 20 years for AVN at PD Hinduja Hospital and MRC by Dr Sanjay Agarwala they immediately contacted the expert We were able to reverse the disease immediately as the diagnosis was established on timeUnfortunately people in India who are unaware of the disease and live in rural areas may ignore hip pain and expect it to go away on its own If therapy is delayed AVN can develop and if individuals are diagnosed later in the diseasersquos progression medical treatments will be ineffective The patients would have outlived their medical management window and would require surgeryHow can avascular necrosis be diagnosedVijayvargiya Most importantly if a patient has hip discomfort whether or not it is caused by Covid19 they should not wait for the pain to worsen Make an appointment with an orthopaedic to have a thorough checkup If an MRI is required the expert will take a callHow can avascular necrosis be treatedKasat Core decompression surgery is performed when the AVN is in the first and second stages Moreover joint replacement surgery is the only option to overcome pain in the third and fourth stages of this disease However surgery is not required if AVN diagnosis is carried out at an early stageAre there any precautions to be takenVijayvargiya A discussion about the likelihood of AVN is required Making a diagnosis is difficult Rather than waiting and assuming it is a pain sprain or an accident it is recommended to see an orthopaedic surgeon if the patient has hip discomfort and has had Covid19 and was prescribed steroids to control it A hip MRI is recommended to rule out hip disease Over the previous 35 years MRI has proven to be a fairly safe procedure MRI aids in obtaining evidence of the presence of AVN probably at an early stage when surgery is not required although cure is achievable if the treatment protocol is followed Avoid falling prey to Ayurvedic remedies that are centuries oldAlso Read This Mumbai crowdfunding initiative is helping feed Covidhit residents in Govandi