Functional Recovery and Radiological Down-Staging through Ayurveda management in Bilateral Corticosteroid-Induced Femoral Head Avascular Necrosis: A Case Report

Abstract

Avascular necrosis (AVN) of the femoral head is a progressive ischemic condition that often requires surgical intervention. Corticosteroid therapy during COVID-19 has been linked to aggressive AVN in young adults. In Ayurveda, it corresponds to Asthimajjagata Vata, with classically recommended raktamokshana, basti, snehana–swedana, and rasayana treatments. A 32-year-old male presented with bilateral hip pain and restricted mobility, beginning few months after corticosteroid use during COVID-19 treatment. Patient was wheelchair-dependent, with VAS pain scores of 10/10 (right) and 9/10 (left). MRI (22/12/2024) confirmed bilateral femoral head AVN: right hip Stage III, Mitchell Class D; left hip Stage II, Mitchell Class A. (ICD-11 code FB81.XK9J.XA96S5). Bilateral total hip arthroplasty was advised, but patient declined. A multimodal Ayurvedic protocol, delivered in three 60-day cycles, included siravedha (therapeutic venesection), sequential basti (tikta-ksheera, yogabasti, matra basti), local snehana and swedana, and Panchatikta Ghrita Guggulu, Asthimajjapachaka Vati, Medopachaka Vati, Dashamoola Kwatha, and Asthiposhaka Vati orally. The rationale was to pacify vata, improve circulation, and strengthen bone and marrow. By six months, pain had reduced to 5/10 (right) and 2/10 (left), mobility was restored to independent walking, stair climbing, and hip range of motion markedly improved. Follow-up MRI (18/09/2025) showed bilateral down-staging to Stage II, Mitchell Class B, with reduced articular involvement and no collapse. No adverse events were noted. This case demonstrates a structured Ayurvedic regimen may relieve symptoms, restore function, and arrest progression in corticosteroid-induced AVN. Though not curative, it may serve as a valuable bridging option when surgery is deferred.