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Journal of Orthopaedic Surgery and Research

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Open Access 01-12-2024 | COVID-19 | Systematic Review

The pandemic is gone but its consequences are here to stay: avascular necrosis following corticosteroids administration for severe COVID-19

Authors: Filippo Migliorini, Nicola Maffulli, Tapish Shukla, Riccardo D’Ambrosi, Mohit Singla, Abhishek Vaish, Raju Vaishya

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2024

Abstract

Background

In patients with COVID-19 infection and respiratory insufficiency, corticosteroid (CCS) administration is recommended. Among the wide range of complications and interactions, time-limited high-dose CCS administration might promote avascular necrosis (AVN) in a cumulative dose. This systematic review updated the current evidence and characterises the trend of AVN following time-limited high-dose CCS administration in patients who had severe COVID-19, discussing management strategies and outcomes.

Methods

This systematic review was conducted according to the 2020 PRISMA statement. In October 2023, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Scopus restricting the search to the years 2019 to 2023. All the clinical studies which investigated the association between time-limited high-dose CCS administration in patients with severe COVID-19 infection and AVN were accessed.

Results

A total of 245 patients (9 studies) who experienced AVN following COVID-19 were included in the present investigation. 26% (63 of 245 included patients) were women. The mean age of the patients was 42.9 ± 17.7 years. Four studies focused on AVN of the hip and two on the knee, and the other studies included patients with AVN from mixed areas of the body (spine, pelvis, and shoulder). The mean time elapsed from COVID-19 infection to the development of symptomatic AVN was 79.4 ± 59.2 days (range, 14 to 166 days).

Conclusion

It is possible that even time-limited high-dose CCS administration in patients with severe COVID-19 infection increased the incidence of AVN. The mean time elapsed from COVID-19 infection to the development of symptomatic AVN was approximately 80 days. Given the high risk of bias in all the included studies, the quality of recommendations of the present investigation is low, and no reliable conclusion can be inferred.

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Title: The pandemic is gone but its consequences are here to stay: avascular necrosis following corticosteroids administration for severe COVID-19
Authors: Filippo Migliorini
Nicola Maffulli
Tapish Shukla
Riccardo D’Ambrosi
Mohit Singla
Abhishek Vaish
Raju Vaishya
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: COVID-19
Osteonecrosis
Core Decompression
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2024
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-024-04556-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The pandemic is gone but its consequences are here to stay: avascular necrosis following corticosteroids administration for severe COVID-19

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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