Also known as Avascular Necrosis, Bone death is a medical condition in which there is a hindrance in the bone blood supply which kills it slowly.
Doctors have established a link between Covid-19 recovered patients and Avascular Necrosis (AVN) amidst India’s fight with the repercussions of the deadly second wave of Covid.
Let’s understand what is Bone death
Among the long list of post-Covid complications among the recovered patients, AVN is a new addition. It has recently been observed and is a painful condition that affects the hip joint and thigh bones of Covid-19 patients. In this, the blood supply to the bone gets affected, leading to its gradual death. Because it is bone and there is a lot of structure around the bone, it does not necessarily collapse right away but begins to pain first.
Dr. Sanjay Agarwala, head of orthopedics & traumatology, and Dr. Mayank Vijayvargiya at PD Hinduja Hospital & MRC Mumbai have written a medical paper on their findings related to Bone death. The paper has been accepted for publication by the British Medical Journal (BMJ).
The doctors said, “That sector of the bone dies, just like it would in the heart or the brain.” They also said that people should not associate every piece of pain with AVN because it could be due to strain or injury as well. However, “we know that this can happen in the hip. When you get pain in the hip and if there is a restriction of movement, the person concerned should seek the advice of an orthopedic surgeon.”
First Detection of AVN
The complication came to light when a Covid-19 recovered patient, Dr. Manish Khobragade, suddenly developed pain in the left hip joint. Initially, he ignored it and treated it as a simple joint pain. when it did not subside even after a week, he contacted an orthopedic surgeon. An X-ray test was performed but it didn’t detect any serious issue. Khobragade was hence prescribed regular medications like pain killers and muscle relaxers. But even after a month and a half the there was no relief from the pain.
At that point, Khobragade realized that the pain was something serious. He then got the MRI done post which he was diagnosed with bone death. His condition, by that time, worsened a lot. Even walking became difficult for him. He couldn’t squat at all. Then he met Dr. Agarwala. After six months of treatment, the doctor is now able to walk, climb stairs, squat and continue with his day-to-day activities. But, doctors have advised the treatment course for another two to three years.
Diagnosis and Treatment
According to Doctors, the clinical diagnosis of AVN can be done by an MRI. Simply taking X-ray tests would not be sufficient to identify bone death. The doctors said that the condition can be treated at an early stage if diagnosed.
It was possible to reverse the disease immediately in the first three patients who developed symptoms of AVN because of an early done MRI. They were all doctors and were well aware of the disease. However, if a person keeps on neglecting the pain, the treatment will get delayed and AVN will progress. If the patients come for diagnosis at later stages, containment of the disease will be quite impossible.
Normally, it takes around three years to treat the disease completely. But if the patients react positively to the treatment the pain begins to subside within 3-6 weeks. Since the outbreak of the pandemic last year, a total of 16 patients have been given medication for AVN at the hospital.
Steroid Intake and AVN
Research from around the globe proposes the role of steroids in developing AVN. It shows that AVN can occur with certain doses of steroids. According to doctors, “Patients who have been given steroids to improve lung function which gets affected due to Covid-19, may be prone to get AVN on the hip. We recognized that since the patient has had Covid-19, he may have a chance of thrombosis of his blood vessels and more likely because he has been on steroids.”