Hyperbaric oxygen therapy as a treatment for stage-I avascular necrosis of the femoral head

Abstract

Avascular necrosis (AVN) of the head of the femur is a potentially crippling disease which mainly affects young adults. Although treatment by exposure to hyperbaric oxygen (HBO) is reported as being beneficial, there has been no study of its use in treated compared with untreated patients. We selected 12 patients who suffered from Steinberg stage-I AVN of the head of the femur (four bilateral) whose lesions were 4 mm or more thick and/or 12.5 mm or more long on MRI. Daily HBO therapy was given for 100 days to each patient. All smaller stage-I lesions and more advanced stages of AVN were excluded. These size criteria were chosen in order to compare outcomes with an identical size of lesion in an untreated group described earlier. Overall, 81% of patients who received HBO therapy showed a return to normal on MRI as compared with 17% in the untreated group. We therefore conclude that hyperbaric oxygen is effective in the treatment of stage-I AVN of the head of the femur.

Transient Osteoporosis of the Hip and Hyperbaric Oxygen Therapy: A Report of Two Cases

“…With the administration of HBO, vasoconstriction occurs in the femoral head and tissue edema decreases. When edema disappears, intraosseous pressure decreases and venous drainage and microcirculation improve (10). This effect of HBO is similar to its usage in the treatment of early stage avascular necrosis of the hip.…”

“…In our first case administered HBO therapy, the patient reported that her pain in the hip decreased at the beginning of sessions and a remarkable relief was observed after the completion of 10 sessions. Considering long-term HBO therapy in avascular necrosis of the hip in literature, an extra 10-session therapy was approved for the patient (10,12), and after these additional 10 sessions of therapy, desired improvement was obtained in the patient. Further clinical studies evaluating the efficiency of HBO therapy in TOH and its implementation protocols are required.…”

Treatment with acetylsalicylic acid prevents short to mid-term radiographic progression of nontraumatic osteonecrosis of the femoral head: a pilot study

“…First, the small number of patients in the cohort limits the potential conclusions on the effect of ASA to only patients who present with a round head (no subchondral step). However, it should be noted that the study's sample size is comparable to that of other pilot studies for preventative therapies, including enoxaparin 8 and hyperbaric oxygen, 43,44 for ONFH. Second, the use of historical controls for comparison raises concerns for selection bias or equivalence of populations.…”

“…Medical therapies as well as nonpharmacological therapies, including modified weight bearing, hyperbaric oxygen and extracorporeal shock wave therapy, have been the subject of multiple investigations, including several prospective studies. 18,[32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] Bisphosphonates have received specific attention owing to their known effect of decreasing osteoclast-mediated bone turnover that theoretically could prevent subchondral bone collapse. A randomized controlled trial assessing 54 hips reported significantly lower rates of disease progression and need for arthroplasty in patients treated with bisphosphonates for 2 months.…”

Hiperbarik oksijen tedavisi

“…[38] Reis ve arkadaşları, Steinberg Evre I femur başı avasküler nekrozlu hasta çalışmalarında, HBO tedavisi gören hastaların %81'inde, tedavi edilmeyen gruba kı-yasla manyetik rezonans (MR) görüntülemede normale dönüş belirtileri olduğunu bildirmişlerdir. [39] Olası mekanizma, etkilenen kemiğin oksijenasyonu ile kemik dokuyu eski durumuna getiren mikro-sirkülasyon olayını geri getirmesi olarak düşünülmektedir. Diğer yandan, HBO tedavisinin ölü kemiğin rezorbe edilmesi ve canlı kemik ile yer değiştirme sürecini aktive ettiği de bildirilmektedir.…”