The Morning Journal (Lorain, OH)

What could be cause of sudden osteonecro­sis in knee?

- Contact Dr. Roach at ToYourGood­Health@med.


I am a 69-year-old Caucasian woman with newly found necrosis of the knee bone, along with a fracture. I do not have diabetes, but I received a month of steroids last November when I had COVID. I also use Adair daily for asthma. I am scheduled for total knee replacemen­t this coming October. My primary care doctor, my orthopedis­t and my knee surgeon do not know how this occurred. I would like to know so that I might be able to prevent it from happening in the future. I felt fine until after a long walk three months ago. I’ve had to use a cane for walking ever since, and am unable to walk very far, due to pain.

— S.R.

DEAR READER » Osteonecro­sis, also called avascular necrosis, literally means “death of bone.” The top of the femur in the hip is the most common bone affected, but many other bones can be affected.

I can’t say for sure what caused your knee bone osteonecro­sis, but there are three possibilit­ies I’d consider.

The first is the steroids you took when you had COVID-19. Moderately strong evidence shows that steroids, such as dexamethas­one, reduce the risk of dying in hospitaliz­ed people with COVID who have low oxygen levels (94% or lower). Unfortunat­ely, the dose of steroids used, although it may have been lifesaving, does put people at higher risk for developing osteonecro­sis.

In my opinion, this is the most likely cause.

A second possibilit­y is a rare condition called “spontaneou­s osteonecro­sis of the knee.”

This essentiall­y “unknown cause” tends to affect a specific part of the knee (the medial femoral condyle).

The third possibilit­y I’d consider would be the COVID-19 itself. I found a case series of people with osteonecro­sis that occurred in people with COVID-19 infection. Their doses of steroids were not high. However, all these cases were in the hip, not the knee.

This is not a complete list.

Trauma to the knee, excess alcohol use, smoking, radiation treatment and osteoporos­is medication­s (when used for a very long time) all can predispose to osteonecro­sis.

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