How COVID and steroids are affecting the hips in young adults

In a surprising turn of events post-COVID-19, doctors are noticing a rise in cases of Avascular Necrosis (AVN), a condition causing the death of bone tissue, particularly in the hips. What's more surprising is that this is happening to a much younger crowd, people between 20 to 40 years old, whereas it used to be more common in people in their forties or fifties. If you have been treated for COVID-19 in the past and are now experiencing hip joint pain- early detection could help you! This is not only a red flag for old people but also younger demographic.

Why is this occurring? Steroids were used even earlier for the treatment of conditions like asthma, arthritis, certain malignancies, and various other inflammatory conditions. It was an important risk factor for the development of AVN even then, albeit the incidence was lesser and the condition was much slower in disease progression. On the contrary, we are observing that patients who were affected with COVID and received steroid treatment, even for a short duration and with a lower dose are presenting with a much rapid destruction of the joint. This implies that it’s not just the steroid therapy but also the hypercoagulability and other vascular-related pathologies associated with COVID-19 that are contributing to the musculoskeletal damage. It is unpredictable as to which patient can develop this dreaded complication.

So what are the tell-tale signs to watch out for? It is predominantly pain in the hips, worsening on weight bearing and sometimes occurring even at rest. In the initial stages, it could be asymptomatic. Early detection, helps us identify this condition sooner and take measures to slow down the progression. AVN progresses through multiple stages and may not be detected on X-rays in the initial grade. It can be identified on the x-ray, usually in stage 2 or 3 when there is already a collapse of the femoral head (the ‘ball’ in the hip joint). MRI is the only diagnostic tool that helps us pick up the disease in the initial stages of the pathology. When identified early, patients could benefit from joint preservation procedures like decompression surgery combined with stem cell therapy that can salvage the hip joint. Total hip replacement is recommended for those with collapse of the joint and irreversible damage as in stage 3.

People who have ended up needing hip replacements at a younger age all seemed to have one thing in common – they waited a bit too long before seeking help. Whether it was mild discomfort or thinking the pain was just muscle-related, delaying a visit to the doctor is a common thread.

Do not ignore signs like mild discomfort or pain in the hips, struggling with stairs, sitting, or even doing your favorite recreational activities. When in doubt, don't wait, seek a consultation with a doctor and get appropriate investigations, especially with a background history of covid 19 infection and steroid usage.


Taking better care of our joints and bones, quitting smoking, moderation of alcohol consumption, avoiding steroid abuse, regular exercise, and consuming a diet rich in calcium, vitamin D, and antioxidants will help improve the quality of our bones.

The surge in AVN cases post-COVID-19 infection and steroid usage highlights the multifactorial aspect of AVN. As we navigate the post-COVID healthcare landscape and discover new facets of ‘long COVID’ syndrome, it’s time for everyone, both healthcare providers and the public to stay informed and make screening and early detection a part of the healthcare routine. By improving awareness, we can lessen the impact of unexpected health complications.

(Author: Dr. Kumardev Arvind Rajamanya, Head of Department (HOD) & Lead Consultant – Orthopaedics, Aster Whitefield Hospital, Bengaluru)