Causes & Risk Factors

  • Corticosteroid use
  • In severe COVID‑19 with respiratory distress, corticosteroids like dexamethasone or methylprednisolone are often used. These can impair blood flow to bone tissue, leading to cell death (osteonecrosis).
  • Vascular and thrombotic issues
  • Micro‑emboli, small clots, and disturbed blood flow during or after COVID‑19 can reduce oxygen/nutrient supply to bone and contribute to osteonecrosis.
  • Inflammatory responses and immune dysregulation
  • High inflammation, elevated cytokines, strong immune responses, and disease severity all increase risk of damaging bone microstructure.
  • Dose and duration
  • Higher doses, longer steroid courses, earlier onset of symptoms, and more severe illness raise the risk.

Diagnostics

  • Clinical assessment & symptoms
  • Pain, especially in hip area; limping; movement restriction; worsening with activity.
  • Screening
  • For people in risk groups (e.g. those who used steroids), periodic evaluation; MRT is the most reliable for early detection.
  • Radiological classification
  • Systems like Ficat, ARCO to define stage, presence of collapse, degree of necrosis.

Treatment

Stage Treatment Approach

Early (Ficat I–II, no collapse)

Conservative management: rest, avoid weight‑bearing, NSAIDs, Vitamin D & bone support agents; follow‑up MRT.

Intermediate (Ficat II‑III, beginning collapse)

Core decompression; PRP / BMAC therapies; physical therapy & rehabilitation.

Late (Ficat IV, structural collapse, loss of joint function)

Total joint replacement (prosthesis); bone grafting; long recovery and rehab period.

Prevention

  • Use corticosteroids only when necessary, at minimal effective dose, shortest duration possible.
  • Maintain adequate Vitamin D & calcium levels; good nutrition.
  • Regular safe physical activity.
  • Periodic imaging (MRT or X‑ray) for those at risk.