Femoral condylar necrosis: treatment with hyperbaric oxygen therapy

Abstract

BackgroundOsteonecrosis of the knee (ONK) is a form of aseptic necrosis resulting from ischemia to subchondral bone tissue. Typically, treatment is invasive. Hyperbaric oxygen therapy (HBOT) may provide a noninvasive alternative by improving oxygenation and reperfusion of ischemic areas. This study evaluates the efficacy of HBOT in a series of ONK patients.MethodsThis retrospective study evaluates 37 ONK patients (29 male, 8 female; mean age ± 1 standard deviation: 54 ± 14); 83.7% of patients presented with Aglietti stage I-II; 16.3% presented with Aglietti stage III. Patients were treated with HBOT once a day, 5 days a week, at 2.5 atmosphere absolute with 100% inspired oxygen by mask for an average of 67.9 ± 15 sessions. Magnetic resonance imaging was performed before HBOT, within 1 year after completion of HBOT, and in 14 patients, 7 years after treatment. Oxford Knee Scores (OKSs) were recorded before HBOT and at the end of each HBOT treatment cycle.ResultsAfter the 30 sessions of HBOT, 86% of patients experienced improvement in their OKS, 11% worsened, and 3% did not change. All patients improved in OKS after 50 sessions. Magnetic resonance imaging evaluation 1 year after HBOT completion showed that edema at the femoral condyle had resolved in all but 1 patient.ConclusionsHBOT is beneficial for treating ONK. Patients experienced improvements in pain and mobility as demonstrated by improvement in OKS. Radiographic improvements were also seen upon post-treatment follow-up. Aglietti staging for the entire sample saw an aggregate decrease (P < .01) from 1.7 ± 0.7 to 0.3 ± 0.6.

Assessment of the hyperbaric oxygen therapy effects in distal femoral necrosis using hyperspectral imaging

“…On the other hand, local deoxyhemoglobin levels decreased after tissues exposure to the same HBOT therapy protocol, but without significant difference between normal and necrotic areas, explained by local vasoconstriction. Promising results in the use of HBOT therapy for femoral head necrosis have also been reported in several other studies that have highlighted the HBOT therapy effects based on clinical outcome (range of motion, stabilometry and pain (6) or by magnetic resonance imaging (15,22). However, to our knowledge, the use of hyperspectral imaging to assess the effects of HBOT therapy on femoral condylar necrosis is presented for the first time in this study.…”

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

“…Studies reported radiographic improvement in FHN Stage I according to the Steinberg classification. Additionally, they reported better pain control, compliance, and range of motion (ROM) in FHN at Ficat stages I–II [ 27 , 89 , 90 , 106 , 107 ]. Hyperbaric oxygen therapy also enhances osteoclast and osteoblast function for bone remodeling and repair.…”

“…In pathologies characterized by osteonecroses, such as FHN and osteonecrosis of the knee [ 87 , 89 , 90 ], osteoradionecrosis, mandibular osteomyelitis, and dental implants, HBOT has been successfully used [ 84 ].…”

Hyperbaric Oxygen Therapy and A-PRF Pre-Treated Implants in Severe Periodontitis: A Case Report

“…HBOT also promotes bone regeneration by improving osteosynthesis, neoangiogenesis, and vasculogenesis. It has been successfully used in many pathologies characterized by osteonecrosis, such as avascular necrosis of the femoral head (AVNFH) and osteonecrosis of the knee [ 7 , 8 , 9 ]. In particular, referring to the oral and maxillofacial districts, HBOT increased the bone regeneration rate in osteoradionecrosis, mandibular osteomyelitis, and dental implants [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ].…”