Ayurvedic Protocol in the management of Post-COVID steroid induced Avascular Necrosis: A Case Study

Abstract

Steroid-induced Post-COVID Avascular Necrosis (AVN) of the hip has emerged as a significant musculoskeletal complication. Even though steroids can be life-saving by controlling excessive inflammation, prolonged or high-dose therapy may impair blood supply to the femoral head, leading to ischemia and subsequent bone tissue death. Clinically, AVN presents with persistent hip pain, restricted range of motion, and stiffness. It often progresses to femoral head collapse if not diagnosed and managed early. Imaging techniques such as MRI play a critical role in early detection. In Ayurvedic understanding, there is no direct reference to AVN. It can be correlated with conditions such as Asthi-Majjagata Vata, Asthi-Majja Kshaya, and Ubhyashrita Vatarakta, all of which involve vitiation of Vata dosha affecting the bone (Asthi) and marrow (Majja). These conditions fall under the broader category of Vatavyadhi, or Vata-dominant disorders. Modern medical treatments like NSAIDs, core decompression, bone grafting, and total hip replacement are often expensive, may cause complications, and usually provide only short-term relief. In contrast, Ayurveda offers a holistic and individualized approach aiming at the restoration of dosha balance, rejuvenation of bone tissue (Asthi dhatu), and enhancement of overall vitality. This paper attempts to explore AVN of the femoral head through the lens of Vatavyadhi and discuss an Ayurvedic management protocol involving Snehana (oleation), Swedana (sudation), Basti (medicated enemas), and Rakthamoksha (blood-letting), which may contribute to symptomatic relief, improved joint function, and better quality of life.