Evidence-Supported HBO Therapy in Femoral Head Necrosis: A Systematic Review and Meta-Analysis

Abstract

Although many studies have shown that hyperbaric oxygen (HBO) therapy can significantly improve symptoms and quality of life of patients affected by femoral head necrosis, this therapy is not worldwide approved yet. This meta-analysis was performed to evaluate its clinical effect. Relevant studies published before May 2020 were systematically searched using terms related to HBO and femoral head necrosis. Fixed and random-effects models were used to estimate the odds ratio (OR) with 95% confidence intervals (CI). Subgroup analyses and publication bias tests were carried out to explore potential study heterogeneity and bias. Ten studies involving 353 controls and 368 HBO-treated cases were included, most of which were conducted on Asian population. The clinical effect in the HBO therapy group was 3.84 times higher than in the control group (OR = 3.84, 95% CI (2.10, 7.02), p < 0.00001). Subgroup analyses showed that the clinical effect of HBO therapy was statistically significant in the Asian subpopulation which represented most of the subjects (OR = 3.53, 95% CI (1.87, 6.64), p < 0.00001), but not in the non-Asian subpopulation, probably because of insufficient numerosity (OR = 7.41, 95% CI (0.73, 75.71), p = 0.09). The results of this meta-analysis suggest that patients with femoral head necrosis treated with HBO therapy can achieve a significant clinical improvement.

A General Overview on the Hyperbaric Oxygen Therapy: Applications, Mechanisms and Translational Opportunities

“…G. Finally HBOT can significantly improve symptoms and quality of life of patients affected by femoral head necrosis (ECHM recommendation type II level of evidence B) [ 123 ] as well as the previously mentioned NSTI, gas gangrene and urgent HBO alpha toxin neutralized…”

Glucocorticoid‐induced osteonecrosis in systemic lupus erythematosus patients

“…HBO therapy has been suggested to be an effective option for patients with early‐stage ON 205 . A recent meta‐analysis for 10 studies using HBO therapy as the treatment for ON has identified a significant clinical benefit of HBO therapy on ON in Asian populations 206 . It is necessary to clarify the effect of hyperbaric oxygen therapy on glucocorticoid‐induced ON in the future.…”

Treatment of non‑traumatic avascular necrosis of the femoral head (Review)

“…HBO has proved to be highly effective against early stages of femoral head necrosis, particularly in Asian populations (52)(53)(54)(55). In a recent study (56) on 19 patients with stage II ONFH, 12 (52.2%) underwent core decompression (CD) surgery and 11 (47.8%) received HBO treatment.…”

“…However, 8 patients (34.7%) progressed to a higher radiological stage during the first year of follow-up and the progression rate was similar in both groups. Studies have also shown that HBO therapy is as effective as CD for treating non-traumatic pre-collapsed femoral head AVN and therefore can be used a non-invasive alternative (52)(53)(54)(55)(56). The clinical efficacy of HBO depends on the synthesis of growth factors, which promote wound healing and reduce post-ischemia and post-inflammatory damage (57,58).…”