Avascular Necrosis and Bone Marrow Infarction as a Manifestation of Postcovoid Syndrome

Purpose: To assess the demographic and magnetic resonance imaging (MRI) manifestations of aseptic necrosis and bone marrow infarction in patients before, during, and after the COVID-19 pandemic (2019–2023).

Material and methods: The study included 229 patients diagnosed with aseptic necrosis and bone marrow infarction using MRI between 2019 and 2023. The average age of the participants was 50±10 years. All patients underwent MRI using T₂-weighted imaging (WI), T₁-WI, PD-FS, T₂-WI, and T₁-WI with fat suppression. In patients diagnosed with aseptic osteonecrosis, the following MRI signs were recorded: marginal subcortical pathological MRI signal, narrowing of the joint space, joint effusion, bone marrow edema around the necrosis zone. For bone marrow infarction, the following signs were observed: a pathological MRI signal resembling a “geographic map,” heterogeneous increased signal on T₂-WI and T₁-WI, hyperintensity on STIR, and bone marrow edema around the periphery. Statistical analysis of the data was performed.

Results: The results of the study showed that aseptic necrosis of the joints developed more frequently in young, working-age individuals after the pandemic. An increase in the number of male patients with these pathologies was also noted. The incidence of aseptic necrosis increased by 10 % between 2019 and 2022, while bone marrow infarction increased by 3.5 % between 2019 and 2023. The number of bilateral joint lesions in 2019 was significantly lower (p<0.05) than in the post-COVID period, accounting for 8 % of the total number of patients with aseptic necrosis and bone marrow infarction. An increase in the prevalence of stages II and III of the disease was observed between 2019 and 2023.

Conclusion: The more frequent development of the disease in the most economically active population group (working-age men) with bilateral lesions necessitates the development of preventive measures and a comprehensive rehabilitation program, including potential prosthetic interventions. These measures aim to restore patients’ quality of life and enable them to continue their professional activities.