Hyperbaric Oxygen Therapy
Studies on Avascular Necrosis and HBOT
Avascular Necrosis
HBOT is now approved for the treatment of avascular necrosis.
Avascular Necrosis occurs when bone tissue dies due to a loss of blood supply. This typically occurs at the ends of long bones, such as the hip, knee, shoulder, and ankle.
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Causes include:
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Autoimmune disorders (e.g., lupus)
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Decompression sickness (in divers)
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Pancreatitis
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Gaucher disease
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Trauma (e.g., fractures, dislocations)
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Certain medications (e.g., corticosteroids, chemotherapy drugs)
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Radiation therapy
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Hyperbaric Oxygen Therapy helps avascular necrosis by restoring blood supply to affected areas which can delay or eliminate the need for surgery depending on the stage of the condition.
​Isam Moghamis a , Abduljabbar A. Alhammoud a , Osama Kokash b , Ghalib Ahmed Alhaneedi c,d,* a Orthopedics Department, Hamad Medical Corporation, PO Box, 3050, Doha, Qatar b HBOT Department, Hamad Medical Corporation, PO Box, 3050, Doha, Qatar c Orthopedic Residency Training Program, Hamad Medical Corporation, Qatar d Weil Cornell Medical College, Qatar
ABSTRACT
Background: Core decompression (CD) has been used in the treatment of pre-collapse stages avascular necrosis (AVN) with good results. Hyperbaric oygen therapy (HBO) was used as a non-invasive treatment for pre-collapse stages osteonecrosis with favorable results. This study aimed to compare the outcomes of HBO versus CD in stage II of non-traumatic AVN of the femoral head.
Methods: Data were collected retrospectively for patients with non-traumatic AVN of the femoral head that was confirmed by MRI and underwent HBO or CD between January 2010 and December 2018, with a minimum follow-up of 12 months. Oxford Hip Score (OHS), radiographic progression, and Short-Form 12(SF12) were used to assess the outcomes. Results: Nineteen patients with 23 stage II AVN of the femoral head were included, 12 (52.2%) in CD, and 11 (47.8%) in the HBO group with an average follow-up of 34.2 ± 18.4 months. 66.7% of patients in CD and 81.8% in the HBO group achieved satisfactory hip function outcome with statis tically significant mean Oxford Hip Score (35.8 ± 6.7 and 35.5 ± 5.1) (P 0.009 & .003) respectively. No statistical difference of OHS and SF12 (PCS &MCS) was found between the two groups (P 0.202, 0.128 & .670 respectively). Eight (34.7%) cases progressed to a higher radiological stage at one year follow-up. The rate of progression was not statistically significant between both groups (P 0.469) with no statistical difference of OHS and SF12 (PCS & MCS) in the progressed group (P 0.747, 0.648 & 0.416) respectively.
Conclusion: This study showed that the HBO is promising and as effective as CD in the treatment of non-traumatic pre-collapsed AVN of the femoral head. Hence, HBO could be used as an alternative non-invasive treatment option.