 Good morning, everyone. I'm Dr. Apurva Reddy-Dawoo from MediCity Institute of Medical Sciences, Mitchell. I'm going to present a case of post-COVID-19 avascular necrosis. The objective is to report a case of avascular necrosis of bilateral femoral heads after COVID-19 infection introduction. COVID-19 can have an impact on a variety of body systems. Avascular necrosis as a complication of long COVID-19 is a recent hypothesis documented with a few sporadic cases. The British Medical Journal titled avascular necrosis as a part of long COVID-19, where they have explained that the large-scale use of corticosteroids in COVID-19 cases is expected to trigger a resurgence of avian in post-COVID patients. The patient in our scenario was symptomatic and developed early avascular necrosis 56 days after being diagnosed with COVID-19 infection. Case history, it was a case of 34 years old male patient who was diagnosed with COVID-19 two months ago, for which the patient was admitted in ICU and treated with IV methylprednisolone 80 mg per day for 10 days and IV remidus over. The patient was given oral pridnisolone for 30 days before being discharged. The patient developed pain in both hip joints and the lower back 56 days after being diagnosed with COVID-19. The patient had no prior history of hip pain. Then the patient was referred to the radiology department for an X-ray pelvis with bilateral hip joint and an MRA of bilateral hip joint, which showed avascular necrosis of bilateral femoral heads, visual stage B. This is a radiograph of bilateral hip joints, AP view. Bilateral femoral heads appear normal in size and shape with no evidence of joint space reduction. There's no osteoarthritic changes or fractures were noted in the visualized bone. This is MRA coronal view of bilateral hip joints, T1 mated images showing geographical areas of T1 hyperintensities with an adjacent hypo intense rim. The visualized iliac bones reveal normal signal intensity and visualized muscles appear normal. These are MRA axial view of bilateral hip joints, T2 mated images show geographical areas of hyperintensities with surrounding T2 inner hyperintense and outer hypo intense rim in bilateral femoral heads, suggestive of a double line sign. There is no evidence of restricted diffusion on DWI. This is the coronal stir sequence showing few hyperintensities in astabular roof bilaterally, suggestive of bone marrow edema and mild joint effusion is noted bilaterally. These are MRA sagittal stir sequence right and left showing hyperintensities in astabular roof bilaterally, suggestive of bone marrow edema and mild joint effusion is noted bilaterally. MRA axial diffusion mated images and ADC shows no evidence of restricted diffusion in bilateral hip joints. The above MRA findings are suggestive of avascular necrosis of bilateral hip joints, stage B miscial classification, under spinal anesthesia, core compression, and ERP injection for bilateral femoral heads were performed. Post-operative rehab rehabilitation program consisting of static and dynamic quadriceps strengthening exercises and walker-assisted non-weight bearing ambulation were recommended. Discussion, osteonecrosis is an in-stage condition of femoral head in which there is necrosis of bone, secondary to disruption of blood supply and commonly seen between 30 to 60 years of age with a male predominance. The most common presenting symptom is pain in the region of affected hip, thigh, crown, and buttock. Although few patients may remain asymptomatic until late stages, typically it affects the superior articular surface and begins in the most anterior part of the hip. Corticosteroid use is considered to be one of the most common cause of avascular necrosis development. The pathophysiology of steroid-induced AVN remains unknown. There is a lack of consensus about the dosage and duration of steroids required to develop AVN. According to some publication, AVN development requires a cumulative dose of 2,000 mg alone but some studies have claimed that even 700 mg is the minimum dose required to develop AVN. According to the literature, the interval between corticosteroid administration and the beginning of the symptomatic AVN is usually six months to a year. However, in our case, the patient developed avascular necrosis at an earlier period of two months. We believe COVID-19 is known to cause several thromboembolic complications like myocardial infection and stroke to predispose to the development of avascular necrosis. This factor, in addition to prolonged corticosteroid treatment, increases the risk of developing avascular necrosis. Hence, caution should be advocated in COVID-19 patients with a long duration of steroid treatment and monitored for avascular necrosis. Since steroids are essential component in a treatment of COVID-19 infection, they cannot be avoided. However, if AVN is detected early, the patient's morbidity may be reduced. Since MRA of the hips is the most sensitive and non-invasive diagnostic modality for detecting early avascular necrosis and early MRA should be indicated if there is any clinical suspicion. Although avascular necrosis has been linked to long-term corticosteroid therapy prescribed for treatment of COVID-19, the clinicians should ponder on the fact that the procoagulant state of COVID-19 infection could increase the susceptibility of the person to develop avascular necrosis and consider it as a potential complication. So, the summary of the study is we postulate avascular necrosis of a bilateral femoral heads as a potential complication of COVID-19 pneumonia. 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