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 |
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