Bone Death
What is bone death?
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- The medical term for Bone death is Avascular Necrosis (AVN), which is a condition where the blood supply to the bone gets affected, killing it slowly. Bone tissues die due to a lack of oxygen.
- Covid patients were given steroids to help improve their lung function. The new post-Covid complication was found in patients treated with steroids. Steroids are known to make bones soft and that then reduces blood supply.
- AVN is a painful condition affecting the hip joint and thigh bones of Covid-19 patients who had complications and are recovering.
- Since there is a lot of structure around the bone, it does not collapse right away but begins to pain. AVN leads to tiny cracks in the bone, causing the bone’s eventual collapse
Discovery among doctors who were covid patients
- Manish Khobragade, a recovered Covid-19 patient developed pain in the left hip joint and mistook it for simple joint pain. The pain continued even after one week.
- He consulted an orthopedic surgeon who took X-Rays and found nothing. X-rays do not identify bone death. He prescribed regular medications, pain killers, and muscle relaxants. But even after 45 days, Dr. Manish felt no relief.
- He then got Magnetic resonance imaging (MRI) done that revealed signs of bone death on the head of the thigh bones. However, by that time he could not stand for long hours. Walking became difficult and he could not sit with his knees bend at all.
- Six months after the treatment began, the doctor is now able to walk, climb stairs, squat and continue with his day-to-day activities. But, the treatment will continue for another two to three years.
- The first three patients who had symptoms of AVN were doctors themselves who knew that the pain in the hip joint was something unusual. All three were aged under 40 and developed pain in their femur bone (the highest part of the thigh bone). Since the three sought treatment early, they didn’t require surgery.
Symptoms & Diagnosis
- Doctors advise the help of an Ortho surgeon when one feels pain in the hip that restricts movement. The best way to confirm is to get a clinical diagnosis from an MRI. This is the most sensitive test available now. Early detection assures better treatment.
- Symptoms include pain in the joints of the hip, shoulder, knee, hand, and feet. Medical assistance should be sought if the pain is permanent in any joint.
- Once treatment begins the pain subsides within 3 to 6 weeks though it takes nearly three years to treat the disease completely. Treatments include physiotherapy, surgery, and medication.
- If the pain is neglected and the treatment is delayed, AVN progresses, and at later stages, it cannot be controlled. In advanced stages, surgery is required.
- It can lead to a collapse of the head of the femur and arthritis which will eventually lead to them needing a total hip replacement surgery. It starts with a groin or thigh pain that later goes down to the knee
Steroid use
- Since it is an emerging trend, there is no government data regarding AVN but hospitals in Mumbai and Delhi have confirmed such cases.
- Doctors say that steroids cannot be avoided but point out that chances of developing AVN of the hip increase. High doses of steroids in the treatment of the Covid should be avoided.
- Steroids were used illogically especially during the second wave. AVN develops five to 12 months after exposure to steroids and so cases will rise in the coming months.
- It is not clear whether the Covid virus leads to AVN or if it is the steroid use alone, or its combination. Doctors are now studying whether these patients were in the early stages of bone death.
Covid Complications
- Most of the time, covid patients experience blood clotting.
- Mucormycosis, new diabetes, blood clots, heart, respiratory and pulmonary complications, and longer hospitalization for COVID care are being reported across the country.
- Mucormycosis called the Black Fungus affected many covid patients and doctors called it a result of the treatment. This fungal infection mostly affected the COVID-19 patients with uncontrolled diabetes and who stayed long in the intensive care units (ICU).
- People who were on medication were affected as it reduced their ability to fight environmental organisms that cause disease.
- Heavy drinking is one of the top risk factors for developing avascular necrosis. Most blockages of blood supply to the bones are from tiny bits of fat and doctors advise keeping cholesterol levels down as a precaution. Smoking increases the risk even more.
- One should also intimate his doctor about past or present use of steroids.