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Journal of Bone and Joint Surgery - British Volume, Vol 85-B, Issue 3, 371-375.
doi: 10.1302/0301-620X.85B3.13237  
Copyright © 2003 by British Editorial Society of Bone and Joint Surgery
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Hyperbaric oxygen therapy as a treatment for stage-I avascular necrosis of the femoral head

N. D. Reis, MBBS, FRCS Ed, Orthopaedic Surgeon1; O. Schwartz, MD, Orthopaedic Registrar1; D. Militianu, MD, Musculoskeletal Radiologist1; Y. Ramon, MD, Plastic Surgeon and Hyperbaric Medicine Physician1; D. Levin, MD, Orthopaedic Surgeon1; D. Norman, MD, Orthopaedic Surgeon1; Y. Melamed, MD, Director Rambam Hyperbaric Unit2; A. Shupak, MD, Colonel3; D. Goldsher, MD, Director MRI Unit1; and C. Zinman, MD, Head of Orthopaedic Department1

1 Department of Orthopaedics B, Rambam Medical Centre, Faculty of Medicine, Technion-Israel Institute fo Technology, Haifa, Israel.
2 Rambam Hyperbaric Unit, Elisha Hostpital, Haifa, Israel.
3 Institute of Maritime Medicine, Israel Defence Forces, Haifa, Israel.

Correspondence should be sent to Professor N. D. Reis at Elisha Hospital, 12 Yair Katz Street, Haifa 34636, Israel.

A vascular necrosis (AVN) of the head of the femur is a potentially crippling disease which mainly affects young adults. Although treatment by exposure to hyperbaric oxygen (HBO) is reported as being beneficial, there has been no study of its use in treated compared with untreated patients. We selected 12 patients who suffered from Steinberg stage-I AVN of the head of the femur (four bilateral) whose lesions were 4 mm or more thick and/or 12.5 mm or more long on MRI. Daily HBO therapy was given for 100 days to each patient. All smaller stage-I lesions and more advanced stages of AVN were excluded. These size criteria were chosen in order to compare outcomes with an identical size of lesion in an untreated group described earlier. Overall, 81% of patients who received HBO therapy showed a return to normal on MRI as compared with 17% in the untreated group. We therefore conclude that hyperbaric oxygen is effective in the treatment of stage-I AVN of the head of the femur.




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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General