Hyperbaric oxygen therapy is effective and safe for femoral head osteonecrosis: a prospective midterm outcome study.

Abstract

The study aims to assess the effect of hyperbaric oxygen therapy (HBOT) on the radiological and clinical outcomes in patients with early Osteonecrosis of the femoral head (ONFH) at mid-term follow-up. A prospective observational study was conducted on patients with Osteonecrosis of the femoral head (ONFH). ONFH was diagnosed based on plain radiographs and MRI of the bilateral hips. ARCO stages 1-3A of ONFH patients were included with non-traumatic etiologies. Each patient received 5 sessions of HBOT per week for a total of 35 sessions. Repeat MRI was done within 6 weeks of completion of HBOT sessions, at 1 year and 2 years of follow-up. The pre-treatment and last follow-up (2 years) clinical (Harris Hip Scores, VAS Scores) and radiological parameters (JIC Classification, ARCO Staging, Modified Kerboul Angle, Bone marrow edema severity) were compared. At the final follow-up, there was a significant improvement in the mean Harris Hip Score (p = 0.001) and VAS Score (p = 0.001). There was also a significant improvement in the JIC classification (p = 0.03), Modified Kerboul Angle (p = 0.001) and Bone marrow edema grading (p = 0.001) at the final follow-up. HBOT provides good clinical and radiological improvement and is an effective, safe, and non-invasive treatment for patients in the early stages of ONFH. Its role in the early collapse stage needs further validation by higher-level, prospective, large-scale RCTs.