Hyperbaric oxygen therapy ameliorates osteonecrosis in patients by modulating inflammation and oxidative stress

Gerardo Bosco,Giuliano Vezzani,Simona Mrakic Sposta,Alex Rizzato,Garrett Enten,Abdullah Abou-Samra,Sandro Malacrida,Silvia Quartesan,Alessandra Vezzoli,Enrico Camporesi

doi:10.1080/14756366.2018.1485149

Abstract

Early stages of avascular necrosis of the femoral head (AVNFH) can be conservatively treated with hyperbaric oxygen therapy (HBOT). This study investigated how HBOT modulates inflammatory markers and reactive oxygen species (ROS) in patients with AVNFH. Twenty-three male patients were treated with two cycles of HBOT, 30 sessions each with a 30 days break between cycles. Each session consisted of 90 minutes of 100% inspired oxygen at 2.5 absolute atmospheres of pressure. Plasma levels of tumor necrosis factor alfa (TNF-α), interleukin 6 (IL-6), interleukin 1 beta (IL-1β) and ROS production were measured before treatment (T0), after 15 and 30 HBOT sessions (T1 and T2), after the 30-day break (T3), and after 60 sessions (T4). Results showed a significant reduction in TNF-α and IL-6 plasma levels over time. This decrease in inflammatory markers mirrored observed reductions in bone marrow edema and reductions in patient self-reported pain.

Highlights

Avascular Necrosis of the femoral head (AVNFH) is a musculoskeletal condition resulting from reduced blood perfusion of the bone tissue
The aim of our study is to investigate hyperbaric oxygen therapy (HBOT) effect on the reactive oxygen species (ROS) production in AVNFH patients and its alteration of inflammatory cytokines levels
0 T0 T1 T2 the 30-day break (T3) T4 time within the literature, calculated baseline plasma cytokine levels indicate an elevated inflammatory state in patients with AVNFH when compared to normal healthy individuals[18,19]

Summary

Introduction

Avascular Necrosis of the femoral head (AVNFH) is a musculoskeletal condition resulting from reduced blood perfusion of the bone tissue. The natural progression of the disease often results in degenerative joint disease or complete joint dissolution[1]. Pathophysiology of AVNFH can be a result of both traumatic and atraumatic factors[2]. AVNFH is typically treated using more invasive interventions such as core decompression or total hip replacement. Ongoing studies are examining new avenues for more conservative treatments, one of which is hyperbaric oxygen therapy (HBOT). HBOT has been found to be a safe and effective therapeutic modality for management of patients with early stages of AVNFH, reducing self-reported pain scores, localized edema, and lesion size upon radiographic imaging[3,4]

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