Covid after-effects: Bone complications on the rise due to use of steroids, say experts

PATNA: Middle-aged people between 30 and 60 years of age, having recovered from Covid-19 should be careful of stubborn hip pain, persisting despite taking painkillers for a couple of months. They need to consult an orthopaedic surgeon to check for avascular necrosis (AVN) of hip head, which is death of bone tissue due to lack of blood supply, associated with long-term steroid use or consuming alcohol, one of the common after-effects of the coronavirus pandemic that also includes heart attack, deep vein thrombosis (a defect in defective blood circulation), cerebral thrombosis, lung and kidney disorders, said experts at the two-day seventh Global Orthopaedic Forum Conference, which culminated in Patna on Sunday. “There has been a fourfold increase in AVN cases postpandemic. From doing roughly one AVN-related hip joint replacement in a year during pre-Covid times to doing four such surgeries in young patients now, I have found that 80% AVN cases now have steroid therapy history and less than 20% do not have steroid therapy history,” said Dr. AS Prasad, 65, a leading private orthopaedician from

Kanpur, who did one such demonstrative live surgery, as part of the conference, at Patna’s Akshat Seva Sadan on Saturday.

“Contrary to what we were taught as a medical student that long-term use of steroids for six months to one year could lead to AVN, we are now getting such cases with short course of steroids along with Covid-19 in young patients. I can say with certainty that Covid-induced AVN cases are up,” said Dr. Prasad, while speaking to HT on the sidelines of the conference. So, what’s the way out? Dr. Ram Prabhoo from Mumbai, a former president of the Indian Orthopaedics Association,

said one must go for an annual Vit D and calcium test to check for bone health and ultrasonography of the abdomen, colonoscopy, and cardiac evaluation after 45 years of age to catch any disease early, besides refraining from smoking and alcoholism. “If you do not diagnose AVN cases early, they may lead to a flattening of the surface of curvature of head of femur with the curvature of cup (acetabulam) in six months to one year and may ultimately require hip joint replacement surgery,” said Dr. Prabhoo. Speaking about other interventions for AVN, Lucknow’s Dr. Anup Agrawal, vice-president of the Indian Orthopaedic Association, said drug therapy was helpful only in stage I and II. “One has to go for surgical intervention like stem cell therapy, platelet rich plasma therapy, bone grafting core decompression and osteotomy or hip conservation surgery, where an orthopaedic surgeon tries to reduce or shift the loading on the hips by cutting the femur neck and realigning it,” said Dr. Agarwal.

Dr. Prabhoo said AVN treatment depended on age and case severity, depending on the four grades of the ailment. “One has to go for hip replacement surgery if the joint has collapsed and one cannot salvage the bone,” he said.

Organising secretary of the conference, Dr Amulya Kumar Singh said the use of steroids to save lives during the pandemic, especially of patients who were on a ventilator and in the intensive care unit (ICU), has had a cascading effect and was leading to osteoporosis, AVN, back pain, sarcopenia (muscle pain), rheumatoid arthritis and weight gain. Dr. Anil Kumar, 63, a local orthopaedic surgeon who was in

ICU for 16 days of his 25 days of hospitalisation due to coronavirus in 2021, said the scars of the pandemic still had not healed.

From weighing 74 kg when he was infected by the SARS CoV-2 virus in May 2021, to losing 30 kg at the time of discharge from Patna’s AIIMS, after 25 days of treatment, he gained 40 kg in the next six months. “I’ve experienced that weight gain has been one of the side-effects of steroid use during Covid. Now, after much weight loss efforts through diet control and regular exercise, I weigh 84 kg,” said Dr. Kumar. Around 800 doctors from all over India took part in the two-day event.

There has been a four-fold increase in AVN cases post-pandemic...I have found that 80% AVN cases now have steroid therapy history and less than 20% do not have steroid therapy history.

DR AS PRASAD, Orthopaedician