Avascular necrosis of the femur following COVID-19: an updated systematic review

BACKGROUND: One of the complications of COVID-19 infection is avascular necrosis of the femoral head. To date, various studies have reported a wide range of osteonecrosis of the femoral head in patients with COVID-19. The previous systematic review included only 14 studies. So, this systematic review aims to update the findings of these studies. METHODS: Databases such as PubMed, Scopus, EMBASE, PsycINFO, Web of Science, and Google Scholar were systematically searched by two independent researchers on April 1st, 2024. RESULTS: A literature search revealed 1229 records, 161 full-texts were evaluated, and finally, 55 studies remained for systematic review. Fifty-five studies were included in this systematic review. Four studies were cross-sectional studies, six were retrospective studies, and the remaining (45studies) were case reports or case-series studies. Totally, 864 cases were included. Except for 12 studies, 43 studies reported the administration of steroid therapy in included cases. The most common underlying conditions were hypertension, followed by diabetes. In 274 (31.7%) of included cases, AVN was bilateral, and both hips were involved. In some studies, non-surgical treatments-including supplement therapy, anticoagulant therapy, physiotherapy, and hyperbaric oxygen therapy-were administered. Several studies reported symptomatic improvement in patients treated with the core decompression approach. Total hip arthroplasty (THA) was the most commonly used surgical treatment. CONCLUSIONS: Avascular necrosis of the femoral head in cases that have survived COVID-19 should be considered carefully as early diagnosis helps to preserve the joint and its function.