VCOM Louisiana Research Day Program Book 2024

Clinical Research

Jacob Michalik, OMS-III; Vince Lands, MD VCOM-Louisiana, Northoaks-Hammond 40 FEMORAL HEAD AVASCULAR NECROSIS FOLLOWING CORTICOSTEROID COVID-19 TREATMENT: A CASE SERIES

Background: Existing studies have established a relationship between AVN and COVID-19, as well as a relationship between AVN and corticosteroid use. The following cases link two previously well-established associations. Patients were treated for COVID-19 infections in the inpatient setting and developed AVN of the femoral head shortly after, presenting with symptoms of mild pain in bilateral hips. Subsequent x-rays showed degeneration of the osseous structures secondary to a loss of blood supply to subchondral bone and patients were treated with core decompression, but required total hip replacement after extensive erosion of osseous structures. Objective: Avascular Necrosis (AVN) is a subtype of osteonecrosis, which is when a disruption of blood supply causes bone death, most commonly in the hips and shoulders. AVN of the femoral head is a form of osteonecrosis localized to the region of femur bone supplied by the foveal and femoral arteries. Disruption of the normal blood supply to subchondral bone eventually leads to a decrease in oxygenation and nutrient supply to surrounding structures, eventually causing cell death and collapse of the osseous structure. The objective of this case series is to suggest an association between COVID-19 and AVN of the femoral head and

discuss the implications of evolving treatment guidelines and use of corticosteroids in the management of COVID-19. Methods: Analysis and discussion of several cases seen and operated on by Vince Lands, MD. Results: Pending, awaiting finalized results from Dr. Lands office. Conclusions: Patients are at an increased risk of developing AVN following the use of corticosteroids. Corticosteroids are effective and widely used to treat COVID-19, but introduce a hypercoagulable/hyperinflammatory state that increases the risk of vascular endothelial dysfunction. Tangipahoa parish is disproportionally susceptible to impacts of COVID-19. The literature and patient cases support a relationship between COVID-19, corticosteroids, and the development of AVN. Best practices would require recommendations to curtail the use of corticosteroids and implement regular screening of those treated with corticosteroids for a prior COVID-19 infection, especially in instances where cumulative dose and duration of therapy were beyond the suggested thresholds. Furthermore, we recommend actions be taken to increase

community awareness in Tangipahoa parish with regards to COVID-19.

57 2024 Via Research Recognition Day