A rare case of arthritis of both hips was presented to Dr Sanjeev Jain, Joint Replacement Surgeon at Dr L H Hiranandani Hospital Powai, in December 2020. The patient was a 42 years old male who seemed well and was living an active lifestyle till early August 2020, when he was infected by the novel coronavirus (COVID 19). He had been otherwise healthy and had no comorbidities.
He developed a severe form of the COVID-19 disease, which was treated as per the standard protocol for such cases. His treatment was completed and tested negative for Covid-19 before discharge by the end of August. However, after discharge, the patient developed pain in both his hip joints, which progressively worsened. He had been admitted, evaluated and treated at other hospitals over two months. An MRI done initially had shown the possibility of post-COVID19 reactive arthritis. This has not been reported earlier. But his pain and disability only worsened over time. He presented in mid-November 2020. At that time, he was completely bedridden and in agonizing pain. He was unable to sit up in bed even with support. The only thing he has crying and no relief from pain-relieving medications. He was evaluated thoroughly and was suspected of having steroid-induced avascular necrosis of both hips.
The post-Covid-19 reactive arthritis seemed to have progressed to such a severe form of arthritis. Seeing the excruciating pain and disability of the patient, a decision was taken to perform a total replacement of both hips of the patient. The patient was operated on both hips by Dr Sanjeev Jain at the end of November and the first week of December in a staged manner. The patient was pain-free immediately after surgery. The patient was able to walk with support the next day after surgery. His second hip fluid intraoperative sample showed mild infection, which was treated with appropriate antibiotics. When the patient came for follow-up 15 days after surgery, he was completely pain-free, was able to walk without support and had got back to his regular activities. He was possibly the first such case who had developed such hip arthritis following infection of coronavirus.
So in Covid-19, a new form of hip problem was presented to us. Whether this is Reactive Arthritis or Post Covid Steroid Induced Avascular Necrosis of the hip or due to low immunity very low-grade infection, only time will tell if we see more such cases. One thing is sure in the orthopaedic speciality that we will see this patient in times to come.
Dr Sanjeev Jain
Full-Time Orthopaedic, Joint Replacement and Sports Medicine Surgeon
Dr L H Hiranandani Hospital, Powai
MCh Orth. (UK), MS Orth, FASIF (Germany)
Fellowship in Knee Reconstruction & Sports Medicine (USA)
Fellowship in Adult Reconstruction Joint Replacement Surgery (USA)
Specialist in Regenerative Biological Orthopaedic Medicine
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