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Journals / The European Research Journal / 2026 / Volume: 11 Issue: 2

Corticosteroids and rising tide in femoral head avascular necrosis following COVID-19: A critical analysis

Levent Demir(Department of Underwater and Hyperbaric Medicine, Kayseri City Training and Research Hospital, Kayseri, Türkiye)0000-0001-6600-7414
Mustafa Avcı(Department of Emergency Medicine, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Türkiye)0000-0002-5018-9070
Tuba Yücel Uçarkuş(Department of Radiology, Kayseri City Training and Research Hospital, Kayseri, Türkiye)0009-0006-2475-8838
Murat Kahraman(Department of Orthopedics and Traumatology, Kayseri City Training and Research Hospital, Kayseri, Türkiye)0000-0002-3821-9767
Mustafa Öztürk(Department Anatomy, Kayseri City Training and Research Hospital, Kayseri, Türkiye)0000-0002-7797-1353
Mehtap Şahingöz Tahta(Department of Medical Services and Techniques, First and Emergency Aid Program, Niğde Zübeyde Hanım Vocational School of Health Services, Niğde Ömer Halisdemir University, Niğde, Türkiye)0000-0003-0180-3019
Selahattin Kılıç(Department of Family Medicine, Kayseri City Training and Research Hospital, Kayseri, Türkiye)0000-0002-9146-645X
Pages
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Publication Date
2025-03-04
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AI Summary & Key Takeaways

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⚡ TL;DR(Too Long; Didn't Read)

Conclusions: The findings indicate that the severity of FHAVN is correlated with corticosteroid use.

📌 3 Key Takeaways

🎯
Objective & Hypothesis:Objectives: During the COVID-19 pandemic, increased corticosteroid use to treat severe cases has been linked to a rise in femoral head avascular necrosis (FHAVN) cases post-recovery.
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Key Findings & Data:This study evaluated FHAVN patients referred to an outpatient clinic after COVID-19, focusing on the severity of FHAVN related to corticosteroid use, and aimed to connect the drug dosage, and disease grade.
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Conclusion & Impact:Conclusions: The findings indicate that the severity of FHAVN is correlated with corticosteroid use.
🔬Design:Research Article
📍Scope:Comprehensive Sample
⚙️Variables:Avascular necrosis · corticosteroids · COVID-19

Abstract

Objectives: During the COVID-19 pandemic, increased corticosteroid use to treat severe cases has been linked to a rise in femoral head avascular necrosis (FHAVN) cases post-recovery. This study evaluated FHAVN patients referred to an outpatient clinic after COVID-19, focusing on the severity of FHAVN related to corticosteroid use, and aimed to connect the drug dosage, and disease grade. Methods: The study was prospectively designed. Patients diagnosed with FHAVN who received corticosteroids for COVID-19 were included. Data collected included demographic information, medical history, corticosteroid dosage, and magnetic resonance imaging results for radiological grading. Results: A total of 48 patients were evaluated, with a mean age of 46.13 years. A significant majority (81.3%) of the respondents had bilateral FHAVN. The patients received a mean prednisolone equivalent dose of 1295.16±857.98 mg over approximately 18 days. This study found a significant positive correlation between the severity of FHAVN and the dosage and total corticosteroid treatment time. Conclusions: The findings indicate that the severity of FHAVN is correlated with corticosteroid use. Although corticosteroids have shown benefits in severe COVID-19 cases, their prolonged and high-dose administration poses risks, including the development of FHAVN.

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Cite This Article

Demir, L., Avcı, M., Uçarkuş, T. Y., Kahraman, M., Öztürk, M., Tahta, M. Ş., Kılıç, S. (2025). Corticosteroids and rising tide in femoral head avascular necrosis following COVID-19: A critical analysis. The European Research Journal, Volume: 11 Issue: 2. https://doi.org/10.18621/eurj.1607778

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References (28)

  1. Konarski W, Poboży T, Śliwczyński A, et al. Avascular Necrosis of Femoral Head-Overview and Current State of the Art. Int J Environ Res Public Health. 2022;19(12):7348. doi: 10.3390/ijerph19127348.
  2. Liu N, Zheng C, Wang Q, Huang Z. Treatment of non-traumatic avascular necrosis of the femoral head (Review). Exp Ther Med. 2022;23(5):321. doi: 10.3892/etm.2022.11250.
  3. Huang C, Wen Z, Niu J, Lin S, Wang W. Steroid-Induced Osteonecrosis of the Femoral Head: Novel Insight Into the Roles of Bone Endothelial Cells in Pathogenesis and Treatment. Front Cell Dev Biol. 2021;9:777697. doi: 10.3389/fcell.2021.777697.
  4. Dhanasekararaja P, Soundarrajan D, Kumar KS, Pushpa BT, Rajkumar N, Rajasekaran S. Aggressive Presentation and Rapid Progression of Osteonecrosis of the Femoral Head After COVID-19. Indian J Orthop. 2022;56(7):1259-1267. doi: 10.1007/s43465-022-00635-2.
  5. Parikh S, Gomez O, Davis T, Lyon Z, Corces A. Avascular Necrosis as a Sequela of COVID-19: A Case Series. Cureus. 2023;15(2):e35368. doi: 10.7759/cureus.35368.
  6. Migliorini F, Maffulli N, Shukla T, et al. The pandemic is gone but its consequences are here to stay: avascular necrosis following corticosteroids administration for severe COVID-19. J Orthop Surg Res. 2024;19(1):135. doi: 10.1186/s13018-024-04556-8.
  7. Aşçıbaşı K, Özçete ZA. Evaluation of psychiatric symptoms in patients diagnosed with fibromyalgia during COVID-19 pandemic: a cross-sectional study. Eur Res J. 2022;8(6):762-770. doi:10.18621/eurj.1125754
  8. Demirhan E, Atar S, Er G, Okutan İ, Kuru Ö. Postdischarge pain, fatigue severity and quality of life in COVID-19 survivors. Eur Res J. 2023;9(1):57-65. doi:10.18621/eurj.1034610.
  9. Assad SK, Sabah M, Kakamad FH, et al. Avascular necrosis of femoral head following COVID-19 infection. Ann Med Surg (Lond). 2023;85(9):4206-4210. doi: 10.1097/MS9.0000000000001098.
  10. Czock D, Keller F, Rasche FM, Häussler U. Pharmacokinetics and pharmacodynamics of systemically administered glucocorticoids. Clin Pharmacokinet. 2005;44(1):61-98. doi: 10.2165/00003088-200544010-00003.
  11. Ficat RP. Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg Br. 1985;67(1):3-9. doi: 10.1302/0301-620X.67B1.3155745.
  12. Yang JW, Yang L, Luo RG, Xu JF. Corticosteroid administration for viral pneumonia: COVID-19 and beyond. Clin Microbiol Infect. 2020;26(9):1171-1177. doi: 10.1016/j.cmi.2020.06.020.
  13. Mattos-Silva P, Felix NS, Silva PL, et al. Pros and cons of corticosteroid therapy for COVID-19 patients. Respir Physiol Neurobiol. 2020;280:103492. doi: 10.1016/j.resp.2020.103492.
  14. Li H, Chen C, Hu F, et al. Impact of corticosteroid therapy on outcomes of persons with SARS-CoV-2, SARS-CoV, or MERS-CoV infection: a systematic review and meta-analysis. Leukemia. 2020;34(6):1503-1511. doi: 10.1038/s41375-020-0848-3.
  15. Roessler P, Roizen G, Ibáñez S, Valenzuela O. Use of Corticosteroids in COVID-19: Should It Be Considered as a Standard-of-Care Therapy? J Clin Rheumatol. 2021;27(2):46-49. doi: 10.1097/RHU.0000000000001701.
  16. Horby P, Lim WS, Emberson JR, et al; RECOVERY Collaborative Group. Dexamethasone in Hospitalized Patients with Covid-19. N Engl J Med. 2021;384(8):693-704. doi: 10.1056/NEJMoa2021436.
  17. Agarwal A, Hunt B, Stegemann M, et al. A living WHO guideline on drugs for covid-19. BMJ. 2020;370:m3379. doi: 10.1136/bmj.m3379.
  18. Wang Y, Jiang W, He Q, et al. A retrospective cohort study of methylprednisolone therapy in severe patients with COVID-19 pneumonia. Signal Transduct Target Ther. 2020;5(1):57. doi: 10.1038/s41392-020-0158-2.
  19. Fadel R, Morrison AR, Vahia A, et al; Henry Ford COVID-19 Management Task Force. Early Short-Course Corticosteroids in Hospitalized Patients With COVID-19. Clin Infect Dis. 2020;71(16):2114-2120. doi: 10.1093/cid/ciaa601.
  20. Papic I, Bistrovic P, Cikara T, et al. Corticosteroid Dosing Level, Incidence and Profile of Bacterial Blood Stream Infections in Hospitalized COVID-19 Patients. Viruses. 2024;16(1):86. doi: 10.3390/v16010086.
  21. Zhang S, Wang C, Shi L, Xue Q. Beware of Steroid-Induced Avascular Necrosis of the Femoral Head in the Treatment of COVID-19-Experience and Lessons from the SARS Epidemic. Drug Des Devel Ther. 2021;15:983-995. doi: 10.2147/DDDT.S298691.
  22. Hassan AAA, Khalifa AA. Femoral head avascular necrosis in COVID-19 survivors: a systematic review. Rheumatol Int. 2023;43(9):1583-1595. doi: 10.1007/s00296-023-05373-8.
  23. Chan KL, Mok CC. Glucocorticoid-induced avascular bone necrosis: diagnosis and management. Open Orthop J. 2012;6:449-57. doi: 10.2174/1874325001206010449.
  24. Murugesan L, Sivakumar N, Ramamoorthy L, Farooq U. COVID-19-Associated Bilateral Avascular Necrosis of Femoral Head in a Young Male Without Corticosteroid Exposure: A Case Report. Cureus. 2024;16(4):e57525. doi: 10.7759/cureus.57525.
  25. Ölmez H, Tosun M, Ünver E, Doğan M, Arslan Işık N. COVID-19 and hypercoagulability. Eur Res J. 2021;7(2):209-217. doi:10.18621/eurj.830973.
  26. Fouda EAAM, Badr EA, Gawesh D, Mahmoud MA. The role of NOS3-rs1799983 and NOS3- rs2070744 SNP in occurrence of avascular necrosis as a post COVID-19 complication. BMC Med Genomics. 2024;17(1):217. doi: 10.1186/s12920-024-01928-1.
  27. Nhean S, Varela ME, Nguyen YN, et al. COVID-19: A Review of Potential Treatments (Corticosteroids, Remdesivir, Tocilizumab, Bamlanivimab/Etesevimab, and Casirivimab/Imdevimab) and Pharmacological Considerations. J Pharm Pract. 2023;36(2):407-417. doi: 10.1177/08971900211048139.
  28. Beytemur O, Dasci MF, Gök Yurttaş A, Bayrak BY, Alagöz E. The protective role of vitamins C and E in steroid-induced femoral head osteonecrosis: An experimental study in rats. Jt Dis Relat Surg. 2024;35(1):72-84. doi: 10.52312/jdrs.2023.1405.