COVID-19 Enfeksiyonu Sonrası Femur Başının Bilateral Avasküler Nekrozu: Bir Olgu Sunumu

Amaç: Femur başının avaskuler nekrozu, yetersiz kan akımı neticesinde gelişen, eklem hareket açıklığında kısıtlanma, ağrı ve yürüme bozukluğu ile karakterize bir tablodur. COVID-19 ve avasküler nekroz arasındaki ilişkiyi değerlendirmeyi amaçlıyoruz. Olgu: Burada, COVID-19 sonrası her iki taraf femur başında avaskuler nekroz gelişen 63 yaşında bir erkek hastayı sunuyoruz. Sonuç: Tek başına COVID-19 enfeksiyonu veya tedavi etmek için verilen kortikosteroidler, femur başı avasküler nekroz insidansını artırabilir. Kalça MRG, erken evre femur başı avasküler nekrozunu saptamada oldukça spesifiktir ve hastanın sakatlığını ve ameliyat ihtiyacını azaltabilir.

Bilateral Avascular Necrosis of the Femoral Head After COVID-19 Infection: A Case Report

Aim: Avascular necrosis of the femoral head is a condition characterized by limited range of motion, pain, and gait disturbance resulting from insufficient blood flow. We aim to evaluate the relationship between COVID-19 and avascular necrosis. Case: Herein, we present a 63-year-old male patient who developed avascular necrosis of the bilateral femoral head after COVID-19. Conclusion: COVID-19 infection alone and corticosteroids given to treat it can increase the incidence of avascular necrosis of the femoral head. MRI of the hip is highly specific in detecting early stagea vascular necrosis of the femoral head and can reduce patient’s disability and need for surgery.

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1. Kordzadeh-Kermani E, Khalili H, Karimzadeh I. Pathogenesis, clinical manifestations and complications of coronavirus disease 2019 (COVID-19). Future Microbiol 2020;15(13):1287- 1305.
2. Agarwala SR, Vijayvargiya M, Pandey P. Avascular necrosis as a part of ‘long COVID-19’. BMJ Case Rep 2021;14(7):e242101.
3. Malizos KN, Karantanas AH, Varitimidis SE, Dailiana ZH, Bargiotas K, Maris T. Osteonecrosis of the femoral head: Etiology, imaging and treatment. Eur J Radiol 2007;63(1):16- 28.
4. Zalavras CG, Lieberman JR. Osteonecrosis of the femoral head: Evaluation and treatment. J Am Acad Orthop Surg 2014;22(7):455-464.
5. Assouline-Dayan Y, Chang C, Greenspan A, Shoenfeld Y, Gershwin ME, editors. Pathogenesis and natural history of osteonecrosis. Seminars in arthritis and rheumatism; 2002: Elsevier.
6. Thakur M, Datusalia AK, Kumar A. Use of steroids in COVID-19 patients: A meta-analysis. Eur J Pharmacol 2022;914:174579.
7. Chang C, Greenspan A, Gershwin ME. The pathogenesis, diagnosis and clinical manifestations of steroid-induced osteonecrosis. J Autoimmun 2020;110:102460.
8. Li W, Huang Z, Tan B, Chen G, Li X, Xiong K, Zhu R, Li R, Li S, Ye H, Liang Z, Dong X, Zhou S, Chen S, Xi H, Cheng H, Xu R, Tu S, Chen Z, Qi L, Song J, Xiao R, Liu H, Nan Q, Yu H, Cui H, Shen Y, Wang C, Lin N, Zhang Y, Chen W. General recommendation for assessment and management on the risk of glucocorticoid-induced osteonecrosis in patients with COVID-19. J Orthop Translat 2021;31:1-9.
9. Mirzai R, Chang C, Greenspan A, Gershwin ME. The pathogenesis of osteonecrosis and the relationships to corticosteroids. J Asthma 1999;36(1):77-95.
10. Daltro G, Franco B, Veiga D, Faleiro T, Lima V, Vitório F. Osteonecrosis development post Covid-19 infection. J Regen Biol Med 2021;3(5):1-8.
11. Disser NP, De Micheli AJ, Schonk MM, Konnaris MA, Piacentini AN, Edon DL, Toresdahl BG, Rodeo SA, Casey EK, Mendias CL. Musculoskeletal consequences of COVID-19. JBJS 2020;102(14):1197-1204.
12. Awosanya OD, Dalloul CE, Blosser RJ, Dadwal UC, Carozza M, Boschen K, Klemsz MJ, Johnston NA, Bruzzaniti A, Robinson MC, Srour EF, Kacena MA. Osteoclast-mediated bone loss observed in a COVID-19 mouse model. Bone 2022;154:116227.
13. Daltro G, Silva I, Daltro P, Silva I, Botelho V. SARS-CoV-2/ COVID-19 and its implications in the development of osteonecrosis. J Regen Biol Med 2020;2(4):1-19.