Hyperbaric Oxygen Therapy for Avascular Necrosis of the Femoral Head: A Comprehensive Review and Treatment Perspective
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Abstract
Avascular necrosis (AVN) of the femoral head is a progressive orthopedic condition marked by bone tissue death due to impaired blood supply. It predominantly affects young and middle-aged adults and can result in femoral head collapse, joint degeneration, and functional disability if left untreated. Conventional therapies, including pharmacological agents and surgical interventions, often fail to prevent disease progression or restore joint integrity, especially in advanced stages. This review aims to provide a comprehensive overview of AVN pathophysiology, clinical presentation, and classification systems, while critically evaluating the emerging role of hyperbaric oxygen therapy (HBO2T) as an adjunct or alternative treatment. A structured literature review was conducted to synthesize clinical evidence from observational studies, randomized controlled trials (RCTs), case reports, and systematic reviews assessing the efficacy and mechanisms of HBO2T in treating AVN of the femoral head.
The results showed that HBO2T enhanced oxygen delivery to ischemic bone, stimulated angiogenesis, reduced inflammation and marrow edema, and promoted osteoblast activity–mechanisms directly addressing AVN pathogenesis. Clinical studies consistently report improvements in pain, function, radiographic outcomes, and a delayed need for surgical intervention, particularly when HBO2T is initiated in early disease stages. Despite growing global support, HBO2T research in Thailand remains limited due to funding constraints, despite an increasing pool of trained specialists.
In conclusion, HBO2T represents a promising, biologically sound treatment for early-stage femoral head AVN. Its inclusion in clinical protocols may significantly improve patient outcomes and reduce the need for invasive procedures. Larger multicenter RCTs and investment in local research infrastructure are crucial to establish standardized treatment guidelines and expand access, particularly in resource-limited settings.
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