What Is Avascular Necrosis in post-COVID patients? here’s what we know

A new post-COVID complication – Avascular necrosis (AVN) in COVID-recovered patients – has been detected in a few patients in Mumbai and Delhi.

New Delhi: Ever since the COVID-19 pandemic hit the world, we are constantly discovering something new related to the virus and the complications around it.

From Mucormycosis to Cytomegalovirus, there have been some complications that doctors have been discovering in post COVID patients.

Now, a new post-COVID complication – Avascular necrosis (AVN) in COVID-recovered patients – has been detected in a few patients in Mumbai and Delhi.

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While three cases were reported in Mumbai’s PD Hinduja Hospital, all aged under 40 years, three separate cases were reported in Delhi’s BLK Super Specialty Hospital.

What is Avascular Necrosis?

According to Johns Hopkins University School of Medicine, avascular necrosis is a disease that results from the temporary or permanent loss of blood supply to the bone. The bone tissue dies and the bone collapses when the blood supply is cut off.

This can happen in any bone and it commonly happens at the ends of a long bone. It can affect one or several bones at one time or different bones at different times.


Overuse of steroids during the treatment of COVID-19 is the major suspect behind this bone damage as medicines can reduce the blood flow in the body, according to the doctors. COVID patients without any prior hip or joint problems can also have AVN complications.


According to a report published in Factchecker, it can be classified into four stages. In stage one, it can only be seen on MRIs and bone scans. In stage two, it can seen on X-rays. In stage three, you’ll need a hip replacement because it starts collapsing. In the fourth stage, hip replacement is the option available where the damaged bone is removed and replaced with prosthetics.

Doctors have stressed on diagnosing the disease early as it can be treated but if it is diagnosed at a later stage, the person may have to undergo a joint replacement.


  • Joint pain
  • Persistent hip pain
  • Limited range of motion due to pain

Is there a treatment yet?

On early suspicion, for a post-COVID-19 patient, it can be diagnosed by early MRI and can be treated with bisphosphonate therapy, reported Factchecker.

According to the doctors, surgery is only required in the final or advanced stage.

Dr Ishwar Bohra, Senior consultant, Joint replacement Surgeon, Centre for orthopaedics, BLK institute for Bone, joint replacement told ANI:

“Bone death is not new, but now is being seen as a post-COVID-19 effect. Like other post-COVID sufferings, recently we are seeing in the bone and joint segment avascular necrosis of the femoral head because lots of steroids use in the Covid treatment. The hip and shoulder are the areas which should not be ignored, if there is pain.”

Is it common?

Not all COVID patients who are on steroids will develop AVN. It happens only in those who are sensitive to certain steroids or those who are prone to developing AVN.

Doctors have said that they are observing a rise in the number of AVN cases after the second wave and the commonality here is that they were all survivors of COVID-19, Factchecker reported.

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