Osteonecrosis of the femoral head : Could oxygen-ozone therapy became a treatment option?

Abstract

Osteonecrosis of the femoral head (ONFH) is caused by inadequate blood supply leading to death of the osteocytes. Subsequently it progresses to collapse of the femoral head and advanced joint destruction. Medical Ozone (MO) causes an increase in the red blood cell glycolysis rate. This leads to the stimulation of 2,3-diphosphoglycerate which leads to an increase in the amount of oxygen released to the tissues. Production of prostacyline, a vasodilator, is also induced by O3. Intra-articular injection of M.O. is often proposed as a conservative treatment for osteoarthritic pain particularly in the knees because it is less expensive or aggressive than other methods, like Hyaluronic acid and total knee replacement. Therefore, it is important to evaluate for the possibility to apply the method at first intraarticularly in hips and then to document its efficacy to patients with avascular necrosis of the femoral head. We prefer to use ultrasound images that ensure the safety and the precision of the injection. We treated a 43 years old female patient with a dominant pain in the left hip and to a lesser extent to the sacroiliac joint for approximately 3 months, grade ??? Steinberg after previous Hyperbaric oxygen therapy (HBO) before. Our treatment was weekly for seven times, intraarticularly, at volume 5 ml and concentration 40mgr O3/ml O2 and in the upper posterior edge 3ml of MO in the same concentration. The evaluation with magnetic resonance imaging (MRI) revealed improvements after the MO treatment and the clinical status gradually improved during the treatment with the patient walking without assistance after the final injection, pain free. The positive outcome of the first case of ONFH treated with intraarticular MO injections led us to believe that this method values further studies.