Post Covid-19, 24-year-old Mumbai woman has hip replacement surgery

Hip replacement was the only option to relieve Khan of the pain. Representation pic

Avascular necrosis (AVN) or osteonecrosis - death of bone tissue due to a lack of blood supply - continues to be a cause of concern in patients post Covid-19 recovery. Doctors said there is an urgent need for more awareness on the judicious use of steroids which cause the complication, and early diagnosis.

A 24-year-old resident of Antop Hill recently underwent hip replacement after she was diagnosed with hip avascular necrosis. Aisha Khan is all set to return to work after a yearlong fight with Covid-19 and the complications that followed after recovery. She works as a lab technician in Khar and caught Covid-19 last year in April.

Dr Tushar Rathod, orthopaedic surgeon, who operated on Khan in a hospital in Sion, said while they are getting many AVN cases post Covid recovery, she was diagnosed in an advanced stage of AVN and hip replacement was the only option to relieve her from the pain.

Aisha Khan was unable to walk to to the pain

"During her Covid-19 treatment, she was on steroids. Steroids are a known risk factor in getting hip AVN in a young patient like Khan. Her MRI and X-Ray showed advanced hip arthritis because of steroid treatment and Covid. She was barely able to walk. We immediately took her up for total hip replacement surgery," said Dr Rathod. He said AVN occurs when there is a temporary or permanent loss of blood supply to the bone. "The bone tissue dies as a result and the bone collapses," Dr Rathod explained.

Khan said four months after her recovery from Covid-19, she was about to join work when she experienced sudden pain while walking. "I suddenly started getting pain and was not able to walk. I had swelling in my legs. I kept hopping from one doctor to another. Some said I had nerve problems and some said I had vitamin deficiency. Finally I was diagnosed with hip AVN. Post the surgery, the pain is gone and am looking forward to returning to normal life and resuming work next month," said Khan.

Delayed diagnosis

Orthopaedic surgeons are seeing many people with delayed diagnosis. Dr Shubranshu Mohanty, professor, orthopaedics, KEM Hospital said they are seeing one or two cases of AVN post Covid-19 recovery in every OPD. "Recently I had a 36-year-old man from the central suburbs diagnosed with AVN. He is in an advanced stage and will require joint replacement surgery. I have a general physician too who is under treatment for AVN and doing much better," said Dr Mohanty.

He explained that they have graded AVN in four stages. "While the first two stages can be treated with oral medication which can last upto three years depending upon the response, stage 3 and 4 are the people who usually have to undergo joint replacement surgery," Dr Mohanty added.

Dr Mohanty said 25% of the AVN patients arrived late requiring joint replacement surgery. Agreeing with Dr Mohanty, Dr Rathod said there is a small epidemic of hip AVN and there is an urgent need for more awareness on both judicious use of steroids and early diagnosis. "While the corticosteroids are life-saving in Covid-19 treatment, they have to be used judiciously and post treatment, we need to educate the patient to be vigilant for signs of steroid complications like AVN," he said.

Dr Mohanty said post

Covid-19 a patient who was on steroids, should look for symptoms like groin pain, back pain, pain in the thigh and buttocks and go for screening like MRI as recommended by the doctor.