Hyperbaric oxygen therapy improved pain and range of motion for patients with Ficat stage II idiopathic femoral head necrosis

1. Pain was significantly reduced following 20 and 30 treatments with HBOT
2. The range of movement was improved following HBOT
Citation/s:1. Camporesi E, Vezzani G, Bosco G, Mangar D, Bernasek T. Hyperbaric oxygen therapy in femoral head necrosis. Journal of Arthroplasty 2010;25(6):118-123.
2. Vezzani G, Caberti L, Cantadori L, Mordacci M, Nicolopolou A, Pizzola A, Valesi M. Hyperbaric oxygen therapy (HBO2) for idiopathic avascular femoral head necrosis (IAFHN): a prospective double-blind randomized trial. Undersea and Hyperbaric Medicine 2005; 32(4):272-273.


Three-part Clinical Question: For patients with Ficat stage II idiopathic femoral head necrosis, does the administration of hyperbaric oxygen result in any improvement in range of motion or pain?
Search Terms: femoral head necrosis, arthroplasty
The Study:Double-blinded randomised controlled trial with intention-to-treat.
The Study Patients: Adult patients with a diagnosis of idiopathic FHN staged at Ficat II after plain X-Ray and MRI confirmation. No specific therapy.
Control group (N = 10; 9 analysed): Air breathing at 2.5ATA, 30 sessions over six weeks for 80 minutes daily.
Experimental group (N = 10; 10 analysed): 100% oxygen breathing on the same schedule
The Evidence:
Outcome
Air Group
Oxygen Group
Difference
95% CI
Mean
SD
Mean
SD
Pain (VAS 0 to 10)
5.3
0.6
1.4
0.3
3.9
3.69 to 4.11
Non-Event Outcomes
Time to outcome
Air group
Oxygen group
P-value
ROM in flexion (degrees - median and range)
30 treatments
76 (50 - 120)
112 (92 - 120)
0.2
ROM Extension (degrees - median and range)
30 treatments
3.0 (0 - 5.0)
20 (15 - 20)
< 0.001
ROM abduction (degrees - median and range)
30 treatments
7.0 (0 -10.0)
35.5 (26.0 - 45.0)
<0.001
Standing load on affected leg (% difference good/affected leg – median and range)
30 treatments
18 (10 - 42)
12 (6 - 22)
0.06
Comments:
1. The RCT was completed immediately following 30 treatments because all control patients were crossed over to receive HBOT. Not clear how that decsion was reached.
2. Cohort follow-up for seven years suggests gains are maintained and no patient required joint replacement during that time.
3. Clinical significance is unclear, but probable true functional improvement for this group.

Appraised by: Mike Bennett m.bennett@unsw.edu.au ;Monday 9th October 2017
Kill or Update By: February 2021


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