Femoral Head Necrosis

Hyperbaric Medicine in Israel – The 25 Year Struggle

Yehuda Melamed

Avascular Necrosis of the head of the femur:

Results of treatment of stage I by Hyperbaric Oxygen as compared to an untreated control group.

O. Schwartz¹, D. Militianu², D. Levin³, D. Norman³, Y. Ramon⁴, A. Shupak⁵, Y. Melamed⁴, C. Zinman³, N.D. Reis³.
^{1Dept. Orthopaedics, Bnai Zion Medical Center, Haifa; ²MRI
Unit, Dept. Radiology, Rambam Medical Center; ³Dept.
Ortopaedics B’, Rambam Medical Center; ⁴Rambam-Elisha
Hyperbaric Medicine Unit, Haifa; ⁵Marine Medicine
Institute, Zahal, Israel.

Purpose: To compare the use of hyperbaric oxygen (HBO)
and non-weight bearing in the treatment of Stage I avascular
necrosis of the femur head (AVNHF) with treatment by non-weight
bearing (NWB) only.

Methods: Vande Berg et al.’s (1) criteria for
irreversibility of sub-chondral lesions assessed for thickness
and length in AVNFH grade I were used to compare 16 AVN hips
treated by HBO with Vande Berg et al.’s group treated by NWB
only. 15 hips were "Idiopathic" AVNFH and 1 hip was in
a steroid treated Lupus Erythematosus. Only AVNFH grade I was
included: cases of bone marrow edema only or transient
osteoporosis were strictly excluded as were higher grades of
AVNFH.

Results: Irreversibility likelihood was 88% for thickness
of lesion for the control group and 10% for the HBO group. For
lesion length irreversibility likelihood was 73% in the controls
as compared to 0% in the HBO treated group. Altogether the HBO
group registered > 90% total resolution or reduction in size
of the sub-chondral lesions (15 hips). The single failure was in
the steroid treated Lupus case.

Conclusions: HBO treatment is highly effective in Idiopathic
Stage I AVNFH.

Ref. Vande Berg BC, Malghem JJ, Lecouvet FE, Jamart J,
Maldague BE: Idiopathic Bone Marrow Edema Lesions of the Femoral
Head: Predictive Value of MR Imaging Findings. Radiology 1999;
212:527-535.}