Benefits of hyperbaric oxygen therapy in a patient with multifocal osteonecrosis mimicking septic arthritis.

Abstract

Osteonecrosis is a progressive disease characterized with bone damage. Glucocorticosteroids, which are used in treatment of many diseases, are believed to be the most important reason for development of non-traumatic osteonecrosis. Osteonecrosis(ON) generally does not affect multiple joints simultaneously and mimic septic arthritis. In this article, we reported a 48-year-old woman with osteonecrosis who received glucocorticosteroids due to autoimmune hepatitis. The onset of the osteonecrosis was mimicking septic arthritis with multiple joint involvements after corticosteroid therapy. Physical examination; there was mild erythema, effusion, warmth, and diffuse tenderness on palpation in bilateral ankles and knees. Significantly intensity changes were compatible with ON in the femur and the tibia, increased fluid in the knee joint and edema in muscle groups and fatty tissue that are around the knee joint were seen on MRI. Other tests were negative for artiritis.Hyperbaric oxygen treatment was used effectively for the treatment of the patient. Patient's complaint of pain was ceased acoording to Visual Analogue Scale and she did no need to much painkiller. The main purpose of the treatment of ON is intended to protect the patient's natural joint structure. HBO and other medical approaches were provided benefit to patients with ON. Because HBO restores tissue oxygenation, reduces oedema, and induces angioneogenesis. By reducing the intraosseous pressure, venous drainage is restored, and the microcirculation is improved.