The next bad news after black fungus: bone death

Express News Service

Many Covid-recovered patients are reporting aches in the joints, hip, shoulder and knee. The condition, called avascular necrosis (AVN) or death of bone or joint, if not managed in time could lead to devastating results. Doctors say, as of now, there is no government data but hospitals across India are receiving such cases, with the patients largely belonging to the 30 to 50 age group. 

Orthopaedic surgeons say that bone death is not a new phenomenon. But its incidence has gone up; it is manifesting a side effect in Covid-recovered patients who put on steroids during their treatment. A high dose and long term use of corticosteroids like methylprednisolone and dexamethasone can cause marrow edema at bone ends which cuts off its own blood supply. The cessation of blood supply leads to tiny cracks in them or it may also lead to the bone losing its smooth shape resulting in severe arthritis. Most affected bones are in the hip area, but shoulder, knee, hand and foot may also be affected. Common symptoms include mild or severe progressive pain in groin, thigh or buttock, shoulder, knee, hand or foot and limp while walking, and difficulty in climbing stairs. 

“Alarmingly, many people have no symptoms in the early stages. So, one must not take pain and stiff joints lightly after Covid. The pain can be mild or severe and is progressive in nature. If there is a pain in groin, thigh or buttock, it could be a symptom of avascular necrosis of the hip,” says Dr HK Mahajan, Anaesthesiologist, Indian Spinal Injuries Centre, Vasant Kunj, adding that “bone death is the next bad news after black fungus”. 

“Bone death is not a new disease, prior to Covid, we were seeing these cases in cigarette and alcohol addicts. Now, it is due to overuse of steroids during Covid treatment. So, Covid patients who have gone through prolonged steroid-use must not smoke or consume alcohol,” says Dr Shuchin Bajaj, Founder Director, Ujala Cygnus Group of Hospitals. 

Treatment
First of all, remember that not every pain is AVN; pain can sometimes be due to a sprain or injury as well. So the first step to treatment is to undergo an MRI which will detect whether it is a case of bone death 
or not. 

Early diagnosis is necessary as it can then be treated by medication and therapy like bed rest, non-steroidal anti-inflammatory agents, blood thinners and physiotherapy. In advanced stages, the options are limited. Hence, high index of suspicion is necessary for the patients complaining of bone and joint pain post Covid. The timeline for occurrence is between two months and one year, say doctors. 

“Treatment involves improvement in the blood supply to prevent the death of bone cells. We use vasodilators and also alter the lipid profile. The third treatment procedure is bisphosphonate therapy using drugs,” says Dr Bajaj. “We suggest joint replacement surgery only if the AVN is in a fairly advanced stage,” says Dr Shubhang Aggarwal, Orthopaedic & Robotic Joint Replacement Surgeon, NHS Hospital, Jalandhar.

Prevention
Maintaining a healthy lifestyle is the best preventive method for any disease, says Dr Mahajan. However, these measures must include limiting your alcohol intake, keeping cholesterol levels low as fat deposits in blood vessels can limit the supply of blood to bones, and quitting smoking.