Orthopaedic Considerations Following COVID-19: Lessons from the 2003 SARS Outbreak.

Abstract

» As the novel coronavirus disease 2019 (COVID-19) outbreak continues to grow, with 2.5 million cases and 169,006 deaths as of late April 2020, according to the U.S. Centers for Disease Control and Prevention, orthopaedic surgeons should anticipate the complications of pharmacotherapy, namely osteonecrosis, in the next several years.» The rate of osteonecrosis in patients with severe acute respiratory syndrome (SARS) treated with high-dose corticosteroids is 5% to 58% and occurs mostly in the first year following the initiation of high-dose corticosteroid therapy.» Patients who had a cumulative corticosteroid dose of ≥3,000 mg and were treated for >25 days are at the highest risk.» Screening with serum markers and treating with bisphosphonates, extracorporeal shock wave therapy, hyperbaric oxygen, enoxaparin, and/or lipo-prostaglandin E1 may be effective means to curb the progression to collapse and the consequent need for joint replacement in these relatively young patients.