The Epidemiology of Osteonecrosis of the Femoral Head in South Korea: An Update in the COVID-19 Era.

Abstract

Osteonecrosis of the femoral head (ONFH) presents significant clinical challenges and variations in epidemiology across regions, with particularly high prevalence in East Asia. This study updates the trends in prevalence and associated medical costs of ONFH in South Korea from 2013 to 2022, with a focus on the impact of the COVID-19 pandemic. We analyzed data from the Health Insurance Review and Assessment database, identifying patients diagnosed with ONFH using specific International Classification of Diseases, 10th revision codes. The study excluded individuals under 20 years and calculated both crude and age-adjusted prevalence rates. We also assessed the total and out-of-pocket medical costs associated with ONFH treatment. From 2013 to 2022, the annual diagnosis of ONFH increased significantly, peaking in 2019 before declining in 2020 and rebounding thereafter. The crude prevalence rose from 74.1 per 100,000 to a peak, then fell during the pandemic, and increased again post-2020. Age-adjusted prevalence remained relatively stable over the study period, despite a slight dip in 2020. Financially, the total medical cost of treating ONFH increased from 26.7 billion Korean Republic won to 41.2 billion Korean Republic won, with the highest out-of-pocket costs recorded in 2020. The prevalence of ONFH in South Korea has generally increased over the past decade, with a temporary decrease observed during the COVID-19 pandemic, likely due to reduced health care access. Concurrently, medical costs associated with ONFH have risen, reflecting both the increasing number of cases and possibly more complex treatments. The pandemic's impact suggests a need for continuous monitoring of health care utilization patterns and cost management in ONFH treatment, especially given the potential long-term effects of COVID-19-related interventions like steroid use.