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Volume 32
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10.3390/pathophysiology32030036
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

Post-COVID-19 Femoral Head Osteonecrosis Exhibits Mast Cell Clusters, Fibrosis, and Vascular Thrombosis: Key Pathological Mechanisms in Long COVID-19 Bone Degeneration

by
Asya Kuliyeva
1,
Natalia Serejnikova
2,*,
Gulnаra Eshmotova
1,
Yulya Teslya
1,
Anastasia Ivina
1,
Alexey Zarov
3,
Michael Panin
4,
Alexey Prizov
4,
Vera Lyalina
5,
Dmitry Shestakov
6,
Alexey Fayzullin
2,
Peter Timashev
2 and
Alexey Volkov
1
1
Department of Pathological Anatomy, Medical Institute, Patrice Lumumba Peoples’ Friendship University of Russia (RUDN University), 117198 Moscow, Russia
2
Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
3
Department of Traumatology, Orthopedics, and Disaster Surgery, N.V. Sklifosovsky Institute of Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
4
Department of Traumatology and Orthopedics, Medical Institute, Patrice Lumumba Peoples’ Friendship University of Russia (RUDN University), 117198 Moscow, Russia
5
Department of Hospital Therapy Named After Academician G.I. Storozhakov Medical Faculty, Pirogov Russian National Research Medical University, 117513 Moscow, Russia
6
Loginov Moscow Clinical Scientific Center, 111123 Moscow, Russia
*
Author to whom correspondence should be addressed.
Pathophysiology 2025, 32(3), 36; https://doi.org/10.3390/pathophysiology32030036
Submission received: 22 May 2025 / Revised: 9 July 2025 / Accepted: 15 July 2025 / Published: 18 July 2025
Versions Notes

Abstract

Background/Objectives: Оsteonecrosis of the femoral head (ONFH) is a common condition in hip surgery, which is characterized by the death of bone cells due to disruption of the blood supply and ultimately irreversible destruction of the hip joint. As a result of the COVID-19 pandemic, a significant increase in the incidence of ONFH has been identified. To better understand the pathogenesis of ONFH in the context of COVID-19, our research aimed to determine pathomorphological changes in articular tissues specific to post-COVID-19 ONFH. Methods: Using morphological, morphometric, and statistical methods, the femoral heads after hip arthroplasty were retrospectively studied in patients with post-COVID-19 ONFH (n = 41) compared to a non-COVID-19 group of patients (n = 47). Results: Оur results revealed that the key morphofunctional biomarkers of post-COVID-19 ONFH were clusters of mast cells, extensive areas of fibrosis, numerous arterial and venous thrombi, and giant cell granulomas. The potential relationship of those morphological features with the action of the SARS-CoV-2 coronavirus was discussed. Conclusions: Mast cells have been proposed as the leading players that may trigger the main molecular and cellular mechanisms in the development of post-COVID-19 ONFH and can be considered a diagnostic sign of the disease.
Keywords: osteonecrosis; femoral head; long COVID-19; articular tissues; pathomorphology; mast cells; fibrosis; thrombosis; giant cells osteonecrosis; femoral head; long COVID-19; articular tissues; pathomorphology; mast cells; fibrosis; thrombosis; giant cells

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MDPI and ACS Style

Kuliyeva, A.; Serejnikova, N.; Eshmotova, G.; Teslya, Y.; Ivina, A.; Zarov, A.; Panin, M.; Prizov, A.; Lyalina, V.; Shestakov, D.; et al. Post-COVID-19 Femoral Head Osteonecrosis Exhibits Mast Cell Clusters, Fibrosis, and Vascular Thrombosis: Key Pathological Mechanisms in Long COVID-19 Bone Degeneration. Pathophysiology 2025, 32, 36. https://doi.org/10.3390/pathophysiology32030036

AMA Style

Kuliyeva A, Serejnikova N, Eshmotova G, Teslya Y, Ivina A, Zarov A, Panin M, Prizov A, Lyalina V, Shestakov D, et al. Post-COVID-19 Femoral Head Osteonecrosis Exhibits Mast Cell Clusters, Fibrosis, and Vascular Thrombosis: Key Pathological Mechanisms in Long COVID-19 Bone Degeneration. Pathophysiology. 2025; 32(3):36. https://doi.org/10.3390/pathophysiology32030036

Chicago/Turabian Style

Kuliyeva, Asya, Natalia Serejnikova, Gulnаra Eshmotova, Yulya Teslya, Anastasia Ivina, Alexey Zarov, Michael Panin, Alexey Prizov, Vera Lyalina, Dmitry Shestakov, and et al. 2025. "Post-COVID-19 Femoral Head Osteonecrosis Exhibits Mast Cell Clusters, Fibrosis, and Vascular Thrombosis: Key Pathological Mechanisms in Long COVID-19 Bone Degeneration" Pathophysiology 32, no. 3: 36. https://doi.org/10.3390/pathophysiology32030036

APA Style

Kuliyeva, A., Serejnikova, N., Eshmotova, G., Teslya, Y., Ivina, A., Zarov, A., Panin, M., Prizov, A., Lyalina, V., Shestakov, D., Fayzullin, A., Timashev, P., & Volkov, A. (2025). Post-COVID-19 Femoral Head Osteonecrosis Exhibits Mast Cell Clusters, Fibrosis, and Vascular Thrombosis: Key Pathological Mechanisms in Long COVID-19 Bone Degeneration. Pathophysiology, 32(3), 36. https://doi.org/10.3390/pathophysiology32030036

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