Difference between revisions of "Camporesi"

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=Hyperbaric oxygen therapy improved pain and range of motion for patients with Ficat stage II idiopathic femoral head necrosis=
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<span style="line-height:normal">'''<span style="font-size:20.0pt"><span style="font-family:" times="" new="" roman",serif"="">Hyperbaric oxygen therapy improved pain and range of motion for patients with Ficat stage II idiopathic femoral head necrosis</span></span>'''</span>
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| '''<span style'''"font-size: 120%;">1. Pain was significantly reduced following 20 and 30 treatments with HBOT</span>'''<br>**<span style'''"font-size: 120%;">2. The range of movement was improved following HBOT</span>'''  
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<span style="line-height:normal">'''<span style="font-size:18.0pt"><span style="font-family:" times="" new="" roman",serif"="">Clinical bottom line:</span></span>'''</span>
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<span style="line-height:normal">'''<span style="font-size:14.0pt"><span style="font-family:" times="" new="" roman",serif"="">1. Pain was significantly reduced following 20 and 30 treatments with HBOT</span></span>'''<br/> <span style="font-size:14.0pt"><span style="font-family:" times="" new="" roman",serif"="">'''2. The range of movement was improved following HBOT'''</span></span></span>
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**Citation/s:'''<span style="font-size: 110%;">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.</span>
 
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2. <span style="font-size: 110%;">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.</span>
 
  
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**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?
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<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">'''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.</span></span></span>
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**Search Terms:''' femoral head necrosis, arthroplasty
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**The Study:'''Double-blinded randomised controlled trial with intention-to-treat.
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<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">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.</span></span></span>
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**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.
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**Control group''' (N = 10; 9 analysed): Air breathing at 2.5ATA, 30 sessions over six weeks for 80 minutes daily.
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&nbsp;
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**Experimental group''' (N = 10; 10 analysed): 100% oxygen breathing on the same schedule
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**The Evidence:'''
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Three-part Clinical Question:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">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?</span></span></span>
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| <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-size: 13px;">Outcome</span>'''</span></span> |||| <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-size: 13px;">Air Group</span>'''</span></span> |||| <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-size: 13px;">Oxygen Group</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-size: 13px;">Difference</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style="font-size: 13px;">95% CI</span>'''</span></span>  
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Search Terms:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">femoral head necrosis, arthroplasty</span></span></span>
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">The Study:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Double-blinded randomised controlled trial with intention-to-treat.</span></span></span>
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">The Study Patients:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Adult patients with a diagnosis of idiopathic FHN staged at Ficat II after plain X-Ray and MRI confirmation. No specific therapy.</span></span></span>
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<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Control group:'''(N = 10; 9 analysed): Air breathing at 2.5ATA, 30 sessions over six weeks for 80 minutes daily.</span></span></span>
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<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Experimental group:'''(N = 10; 10 analysed): 100% oxygen breathing on the same schedule</span></span></span>
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&nbsp;
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">The Evidence:</span></span>'''</span>
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{| class="Table" style="width:450.9pt; border:solid windowtext 1.0pt" width="0"
 
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|^  || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-size: 13px;">Mean</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-size: 13px;">SD</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-size: 13px;">Mean</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-size: 13px;">SD</span>'''</span></span> ||^  ||^ 
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| style="width:104.95pt; border:solid windowtext 1.0pt" width="143" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Outcome</span></span>'''</span></p>
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| style="width:68.2pt; border:solid windowtext 1.0pt" width="93" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Air Group</span></span>'''</span></p>  
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| colspan="2" style="width:139.95pt; border:solid windowtext 1.0pt" width="189" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Oxygen Group</span></span>'''</span></p>  
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| rowspan="2" style="width:62.6pt; border:solid windowtext 1.0pt" width="85" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Difference</span></span>'''</span></p>  
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| rowspan="2" style="width:66.2pt; border:solid windowtext 1.0pt" width="91" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">95% CI</span></span>'''</span></p>  
 
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| '''<span style'''"font-size: 13px;">Pain</span>'''<span style'''"font-size: 13px;"> (VAS 0 to 10) </span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 13px; text-align: center;">5.3</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 13px; text-align: center;">0.6</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 13px; text-align: center;">1.4</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 13px; text-align: center;">0.3</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 13px; text-align: center;">3.9</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 13px; text-align: center;">3.69 to 4.11</span></span>  
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| style="width:104.95pt; border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" width="143" | &nbsp;
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| style="width:68.2pt; border:solid windowtext 1.0pt" width="93" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Mean (SD)</span></span>'''</span></p>
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| colspan="2" style="width:139.95pt; border:solid windowtext 1.0pt" width="189" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Mean</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">('''SD)'''</span></span></span></p>  
 
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| <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-size: 13px;">Non-Event Outcomes</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-size: 13px;">Time to outcome</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-size: 13px;">Air group </span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-size: 13px;">Oxygen group</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style="font-size: 13px;">P-value</span>'''</span></span>  
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| style="width:104.95pt; border:solid windowtext 1.0pt" width="143" |
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Pain</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">(VAS 0 to 10)</span></span></span>
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| style="width:68.2pt; border:solid windowtext 1.0pt" width="93" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">5.3 (0.6)</span></span></span></p>
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| colspan="2" style="width:139.95pt; border:solid windowtext 1.0pt" width="189" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">1.4 (0.3)</span></span></span></p>
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| style="width:62.6pt; border:solid windowtext 1.0pt" width="85" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">3.9</span></span></span></p>
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| style="width:66.2pt; border:solid windowtext 1.0pt" width="91" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">3.69 to 4.11</span></span></span></p>  
 
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| '''<span style'''"font-size: 13px;">ROM in flexion (degrees - median and range)</span>''' || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 13px; text-align: center;">30 treatments</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 13px; text-align: center;">76 (50 - 120)</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 13px; text-align: center;">112 (92 - 120)</span></span> || <span style'''"display: block; text-align: center;"><span style="display: block; font-size: 13px; text-align: center;">0.2</span></span>
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| style="width:104.95pt; border:solid windowtext 1.0pt" width="143" | &nbsp;
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| style="width:68.2pt; border:solid windowtext 1.0pt" width="93" | &nbsp;
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| colspan="2" style="width:139.95pt; border:solid windowtext 1.0pt" width="189" | &nbsp;
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| style="width:62.6pt; border:solid windowtext 1.0pt" width="85" | &nbsp;
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| style="width:66.2pt; border:solid windowtext 1.0pt" width="91" | &nbsp;
 
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| '''<span style'''"font-size: 13px;">ROM Extension (degrees - median and range)</span>''' || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 13px; text-align: center;">30 treatments</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 13px; text-align: center;">3.0 (0 - 5.0)</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 13px; text-align: center;">20 (15 - 20)</span></span> || <span style'''"display: block; text-align: center;"><span style="display: block; font-size: 13px; text-align: center;">< 0.001</span></span>  
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| style="width:104.95pt; border:solid windowtext 1.0pt" width="143" |
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Non-Event Outcomes</span></span>'''</span>
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| style="width:68.2pt; border:solid windowtext 1.0pt" width="93" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Time to outcome</span></span>'''</span></p>
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| style="width:62.3pt; border:solid windowtext 1.0pt" width="85" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Air group</span></span>'''</span></p>
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| style="width:76.15pt; border:solid windowtext 1.0pt" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Oxygen grp</span></span>'''</span></p>
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| colspan="2" style="width:130.3pt; border:solid windowtext 1.0pt" width="177" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">P-value</span></span>'''</span></p>  
 
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| '''<span style'''"font-size: 13px;">ROM abduction (degrees - median and range)</span>''' || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 13px; text-align: center;">30 treatments</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 13px; text-align: center;">7.0 (0 -10.0)</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 13px; text-align: center;">35.5 (26.0 - 45.0)</span></span> || <span style'''"display: block; text-align: center;"><span style="display: block; font-size: 13px; text-align: center;"><0.001</span></span>  
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| style="width:104.95pt; border:solid windowtext 1.0pt" width="143" |
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">ROM in flexion (degrees - median and range)</span></span>'''</span>
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| style="width:68.2pt; border:solid windowtext 1.0pt" width="93" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">30 treatments</span></span></span></p>
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| style="width:62.3pt; border:solid windowtext 1.0pt" width="85" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">76 (50-120)</span></span></span></p>
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| style="width:76.15pt; border:solid windowtext 1.0pt" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">112 (92-120)</span></span></span></p>
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| colspan="2" style="width:130.3pt; border:solid windowtext 1.0pt" width="177" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">0.2</span></span></span></p>  
 
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| '''<span style'''"font-size: 13px;">Standing load on affected leg (% difference good/affected leg – median and range)</span>''' || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 13px; text-align: center;">30 treatments</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 13px; text-align: center;">18 (10 - 42)</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 13px; text-align: center;">12 (6 - 22)</span></span> || <span style'''"display: block; text-align: center;"><span style="display: block; font-size: 13px; text-align: center;">0.06</span></span>  
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| style="width:104.95pt; border:solid windowtext 1.0pt" width="143" |
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">ROM Extension (degrees - median and range)</span></span>'''</span>
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| style="width:68.2pt; border:solid windowtext 1.0pt" width="93" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">30 treatments</span></span></span></p>
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| style="width:62.3pt; border:solid windowtext 1.0pt" width="85" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">3.0 (0-5.0)</span></span></span></p>
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| style="width:76.15pt; border:solid windowtext 1.0pt" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">20 (15-20)</span></span></span></p>
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| colspan="2" style="width:130.3pt; border:solid windowtext 1.0pt" width="177" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">< 0.001</span></span></span></p>
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| style="width:104.95pt; border:solid windowtext 1.0pt" width="143" |
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">ROM abduction (degrees - median and range)</span></span>'''</span>
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| style="width:68.2pt; border:solid windowtext 1.0pt" width="93" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">30 treatments</span></span></span></p>
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| style="width:62.3pt; border:solid windowtext 1.0pt" width="85" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">7.0 (0-10.0)</span></span></span></p>
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| style="width:76.15pt; border:solid windowtext 1.0pt" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">35.5 (26.0-45.0)</span></span></span></p>
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| colspan="2" style="width:130.3pt; border:solid windowtext 1.0pt" width="177" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"=""><0.001</span></span></span></p>  
 
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| style="width:104.95pt; border:solid windowtext 1.0pt" width="143" |
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Standing load on affected leg (% difference good/affected leg – median and range)</span></span>'''</span>
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| style="width:68.2pt; border:solid windowtext 1.0pt" width="93" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">30 treatments</span></span></span></p>
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| style="width:62.3pt; border:solid windowtext 1.0pt" width="85" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">18 (10 - 42)</span></span></span></p>
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| style="width:76.15pt; border:solid windowtext 1.0pt" width="104" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">12 (6-22)</span></span></span></p>
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| colspan="2" style="width:130.3pt; border:solid windowtext 1.0pt" width="177" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:10.0pt"><span style="font-family:" times="" new="" roman",serif"="">0.06</span></span></span></p>
 
|}
 
|}
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**Comments:'''
 
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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.
 
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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.
 
  
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**Appraised by''': Mike Bennett [[mailto:m.bennett@unsw.edu.au | m.bennett@unsw.edu.au]] ;Monday 9th October 2017
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Comments:</span></span>'''</span>
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**Kill or Update By:''' December 2022
+
 
 +
<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">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.</span></span></span>
 +
 
 +
<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">2. Cohort follow-up for seven years suggests gains are maintained and no patient required joint replacement during that time.</span></span></span>
 +
 
 +
<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">3. Clinical significance is unclear, but probable true functional improvement for this group.</span></span></span>
 +
 
 +
&nbsp;
 +
 
 +
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Appraised by:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Mike Bennett [[mailto:m.bennett@unsw.edu.au| <span style="color:blue">m.bennett@unsw.edu.au</span>]] ;Monday 9th October 2017</span></span></span>
 +
 
 +
<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Kill or Update By:</span></span>'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">December 2022</span></span></span>
  
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[[File:sumhorsa.gif|center]]
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[[File:Sumhorsa.gif|center|Sumhorsa.gif]] <span style="display: block; text-align: center;"><span style="color: #8200ff; font-size: 150%;">[[Fractures|BACK]]</span></span>
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<span style="display: block; text-align: center;"><span style="color: #8200ff; font-size: 150%;">[[Fractures | BACK]]</span></span>
 

Latest revision as of 02:29, 3 May 2021

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

Sumhorsa.gif

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