Camporesi

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

Clinical bottom line:

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 grp

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 decision 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:December 2022

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