Temporal onset and steroid-associated risk in post-COVID hip avascular necrosis: A systematic review and pooled analysis

Published Date: 30th October 2025

Publication Authors: Iyengar. KP

Background
Avascular necrosis (AVN) of the hip has emerged as a post-COVID musculoskeletal complication, likely driven by corticosteroid therapy and virus-induced microvascular injury. This study systematically reviews published evidence on post-COVID AVN, analyzing pooled data on latency, cumulative steroid dose, staging, and management outcomes.
Methods
A systematic review and pooled analysis were conducted following PRISMA guidelines. PubMed, Embase and Scopus, were searched up to June 2024 using predefined keywords. Studies reporting AVN of the hip following confirmed COVID-19 infection were included. Quantitative pooling of latency (days from infection to AVN diagnosis) and cumulative steroid dose (mg prednisolone equivalent) was performed using a random-effects model.
Results
Seventeen studies encompassing 209 patients (313 hips) were included. The mean age was 43.7 ± 16.2 years, with a male predominance. Pooled analysis showed a mean latency of 126.48 days (95 % CI: 95.5–157.46) from COVID-19 infection to AVN onset and a mean cumulative steroid dose of 1198.44 mg (95 % CI: 860.99–1535.88). Most cases presented at Ficat–Arlet stages II–III. Core decompression and bisphosphonate therapy were effective in early stages, while total hip arthroplasty was required for advanced disease.
Conclusion
Post-COVID AVN of the hip is a delayed yet potentially preventable sequela associated with corticosteroid exposure and COVID-related vascular injury. The mean latency of 126 days from infection to AVN onset and an average cumulative corticosteroid exposure of 1198 mg prednisolone equivalent underscores the delayed yet dose-dependent nature of this condition.

Regmi, A.; Iyengar, K.P. et al. (2025). Temporal onset and steroid-associated risk in post-COVID hip avascular necrosis: A systematic review and pooled analysis. Journal of Orthopaedics. 72, pp.304-311. [Online]. Available at: https://doi.org/10.1016/j.jor.2025.10.027 [Accessed 17 December 2025].

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