Hyperbaric Oxygen Therapy for Osteonecrosis: A Magical Journey to Restart Bone Healing

     In modern medicine, hyperbaric oxygen therapy has become a star in the treatment of various diseases, especially in the treatment of osteonecrosis. It seems to have initiated a magical healing journey. This article will bring you closer to hyperbaric oxygen therapy, revealing its remarkable effect in combating osteonecrosis and the scientific principles behind it.
I. Overview of Hyperbaric Oxygen Therapy

1. Definition of Hyperbaric Oxygen Therapy: Hyperbaric oxygen therapy (HBOT) places the patient in an environment with higher atmospheric pressure and allows them to inhale 100% pure oxygen. Under such conditions, the tissue oxygen partial pressure and oxygen diffusion capacity increase with the increase in pressure, significantly enhancing the oxygenation level in the blood and body fluids. This treatment modality can not only improve the hypoxic state of systemic or local tissues but also activate a series of biological responses, promote wound healing, enhance immunity, and combat bacterial and viral infections.
2. History of Hyperbaric Oxygen Therapy: The history of hyperbaric oxygen therapy can be traced back to the early 1940s, initially as a means of treating decompression sickness (diving illness). Over time, scientists discovered that hyperbaric oxygen also has therapeutic effects on gas embolism, carbon monoxide poisoning, gangrene, and many other diseases. By the 1960s, with the advancement of medical technology, hyperbaric oxygen chambers were improved and began to be applied worldwide. Since then, the medical community has conducted extensive research on the indications of HBOT, confirming its effectiveness in treating various conditions such as diabetic foot, refractory ulcers, and radiation tissue damage.
   II. Challenges of Osteonecrosis
3. Definition and Causes of Osteonecrosis: Osteonecrosis, also known as aseptic necrosis or ischemic bone disease, is the death of bone tissue due to interrupted or significantly reduced blood flow. It can be caused by various factors such as long-term use of corticosteroids, alcohol abuse, trauma, arthritis, vascular diseases, or thrombosis. Osteonecrosis can occur in any bone but is most common in the hip, knee, and shoulder regions because the blood supply in these areas is relatively poor. Once vascular injury or blockage occurs, it can lead to rapid degeneration of bone tissue.
4. Complexity of Diagnosis: Osteonecrosis may not show obvious symptoms in the early stage, making it difficult to detect and diagnose in a timely manner. Early osteonecrosis can often only be diagnosed through imaging examinations such as MRI, and these examinations are not routine screening methods. Additionally, since osteonecrosis can be triggered by various different etiologies, doctors need to integrate the patient's clinical manifestations, medical history, lifestyle and other information to determine the cause, which further increases the difficulty of diagnosis.
5. Limitations of Treatment Methods: Currently, treatment methods for osteonecrosis mainly focus on slowing the disease progression, alleviating pain, and attempting to repair the damaged bone tissue. Non-surgical treatments, such as the use of anti-inflammatory drugs, drugs that promote blood circulation, and drugs that reduce osteoporosis, have variable effects and cannot specifically address the fundamental problem of insufficient blood supply. Surgical treatments such as core decompression surgery or joint replacement can improve the symptoms of severe osteonecrosis, but they carry a high surgical risk, have a long postoperative recovery period, and may have complications. Moreover, for young patients, the long-term effect after surgery remains uncertain.
   III. Hyperbaric Oxygen and Osteonecrosis Treatment
6. Improving Oxygen Supply to Hypoxic Tissues: In hyperbaric oxygen therapy, the patient is placed in a high-pressure environment and inhales pure oxygen, which leads to a significant increase in the oxygen partial pressure in the blood. This treatment modality can significantly improve the oxygen supply to hypoxic tissues, especially in the areas of osteonecrosis. In these regions, due to vascular obstruction or damage, blood flow is limited, and oxygen transmission is insufficient, resulting in impaired function of bone cells and surrounding supporting tissues. Hyperbaric oxygen therapy promotes the repair and regeneration of damaged cells and accelerates the bone healing process by increasing the oxygen partial pressure in the blood and forcing oxygen molecules into these hypoxic areas.
7. Promoting Angiogenesis and Improving Microcirculation: Hyperbaric oxygen therapy not only increases the oxygen partial pressure but also stimulates the formation of new blood vessels by promoting the release of angiogenic factors, such as vascular endothelial growth factor (VEGF), which is particularly crucial in bone tissue repair. Angiogenesis can improve the microcirculation state of the damaged area, thereby providing more nutrients to the bone tissue and removing metabolic wastes, which contributes to the repair of the osteonecrosis area. The formation of new blood vessels also helps increase local blood flow, further enhancing the oxygenation and nutritional status of the tissue, creating favorable conditions for bone healing.
8. Anti-Inflammation and Immunity Enhancement: Osteonecrosis is often accompanied by local inflammatory responses. Hyperbaric oxygen therapy can reduce the production of inflammatory mediators and inhibit the inflammatory process. Additionally, in a hyperbaric oxygen environment, the function of white blood cells is enhanced, especially their phagocytic and bacterial killing abilities, which helps prevent the occurrence and development of infections. By reducing inflammation and enhancing immunity, hyperbaric oxygen therapy can provide a more stable healing environment for bone tissue, reduce the risk of complications, and contribute to accelerating the bone healing process.
9. Clinical Application: In clinical applications, hyperbaric oxygen therapy is a promising treatment option for patients with early osteonecrosis. Through early intervention, HBOT can slow down or even stop the progression of osteonecrosis, thereby reducing the need for more complex surgical intervention. During the treatment process, the patient enters the hyperbaric oxygen chamber and inhales pure oxygen under the strict supervision of a doctor. The treatment plan is formulated based on the specific condition of each patient but typically includes a series of treatment cycles. Each cycle may include treatment once a day to several times a week, and each treatment session lasts from 90 minutes to 120 minutes.
10. Advantages and Limitations of Hyperbaric Oxygen Therapy: The advantages of hyperbaric oxygen therapy lie in its non-invasive nature and low risk of side effects. Compared to traditional surgical methods, HBOT can provide therapeutic effects without surgery, especially for those who are not suitable for surgery or wish to avoid surgical risks. Moreover, HBOT usually has a shorter recovery period and can quickly improve the patient's quality of life. However, HBOT is not without limitations. The treatment cost is relatively high and it is not applicable to all osteonecrosis patients, especially in the advanced stage of the disease. During the treatment process, patients may encounter ear pressure discomfort, oxygen poisoning, and rare complications related to pressure changes, and therefore, it must be carried out under the supervision of experienced medical personnel.
    In conclusion, the application of hyperbaric oxygen therapy in the field of osteonecrosis reveals its unique value as a non-invasive treatment modality. It not only provides a new treatment option but also becomes a key to changing the disease course in some cases. With the continuous deepening of scientific research, we have reasons to believe that hyperbaric oxygen therapy will occupy a more important position in future orthopedic treatments. Although it is not a panacea, in the treatment journey of osteonecrosis, hyperbaric oxygen therapy is undoubtedly a promising oasis.