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The Hits Keep Coming…Covid-19’s Effects on Orthopedic Health

by Elizabeth Hofheinz, M.P.H., M.Ed.

While we have heard much about the respiratory effects of Covid-19, fewer information has been available on its effects on the musculoskeletal system. New work from Hospital for Special Surgery (HSS) and the Weill Cornell Medical College in New York City has set out to provide new information on this arena.

The authors wrote, “Although clinical data on patients with COVID-19 following the acute care episode have been limited, there are compelling early signs of musculoskeletal dysfunction in patients recovering from COVID-19 and known musculoskeletal pathologies in patients who had SARS. Although not identical, computational biology and in vitro experimental studies have shown a high degree of similarity between the pathological response to SARS-CoV-1 and SARS-CoV-2 infection.”

Co-author Scott Rodeo, M.D., a sports medicine surgeon at HSS, told OSN, “The general purpose of this paper is to point out the potential musculoskeletal consequences of COVID-19. Based on similarities to SARS-CoV-1 in China in 2003, as well as what we are seeing clinically at this time, there may be persistent muscle weakness, myalgias, and muscle dysfunction in patients recovering from COVID-19. This may directly impact recovery from orthopedic surgical procedures.”

Indicating that the mechanistic effects of COVID-19 on skeletal muscle are not fully understood, the authors point to a 2006 paper1 on a mouse model of SARS that found within 4 days of infection, there was a rapid 20% decrease in body mass. They wrote, “There is also evidence from studies where researchers tested human muscle tissue collected from patients with SARS who had died and were able to shed light on the nature of muscle dysfunction as a result of SARS-CoV-1 infection2, 3,4.”

The authors wrote that there is evidence suggesting that “the SARS infection leads to deficits in both muscle strength and endurance, likely due to the proinflammatory effects of the viral infection and the deconditioning that occurs during the convalescent period. The reduced functional capacity of these patients corresponded with decreases in several indices of health-related quality of life.”

Dr. Rodeo told OSN, “Another important point is the immune dysfunction and altered inflammatory response in COVID-19 patients. Surgery, of course, also induces an inflammatory response, and the stress response to surgery when combined with altered immune function in COVID-19 patients may lead to surgical complications. An altered immune/inflammatory response may have a profound effect on wound healing.”

“Another related concern for orthopedic surgery patients is the coagulopathy seen in COVID 19 patients, with risk for deep venous thrombosis following surgery.”

The authors wrote, “The combination of hypercoagulability, leukocyte aggregation, and vessel inflammation may impair bone microvascular blood flow and contribute to the development of osteonecrosis.”

  1. McCray PB Jr, Pewe L, Wohlford-Lenane C, Hickey M, Manzel L, ShiL, Netland J, Jia HP, Halabi C, Sigmund CD, Meyerholz DK, Kirby P, Look DC, Perlman S. Lethal infection of K18-hACE2 mice infected with severe acute respiratory syndrome coronavirus. J Virol. 2007 Jan;81(2):813-21. Epub 2006 Nov 1.
  • Leung TW, Wong KS, Hui AC, To KF, Lai ST, Ng WF, Ng HK. Myopathic changes associated with severe acute respiratory syndrome: a postmortem case series. Arch Neurol. 2005 Jul;62(7):1113-7.
  • Ding Y, Wang H, Shen H, Li Z, Geng J, Han H, Cai J, LiX, Kang W, Weng D, Lu Y, Wu D, He L, Yao K. The clinical pathology of severe acute respiratory syndrome (SARS): a report from China. J Pathol. 2003 Jul;200(3):282-9.
  • Hsiao CH, Chang MF, Hsueh PR, Su IJ. Immunohistochemical study of severe acute respiratory syndrome-associated coronavirus in tissue sections of patients. J Formos Med Assoc. 2005 Mar;104(3):150-6.
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Elizabeth Hofheinz

Two time winner of the MORE award Ms. Hofheinz was the first writer employed by Orthopedics This Week. The MORE award is granted annually by the American Academy of Orthopaedic Surgeons to recognize excellence in journalism. Ms. Hofheinz is currently the Director of Communications for Ortho Spine Partners (OSP).

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