How Hyperbaric Oxygen Therapy (HBOT) Can Help Your Osteonecrosis
Osteonecrosis (ON), also known as avascular necrosis (AVN), is a condition in which bone tissue dies due to a lack of blood supply. If you are suffering from osteonecrosis, you may be experiencing intense pain and limited mobility. At Dr. Adam Fields’ office in Los Gatos, California we are dedicated to providing you with cutting-edge treatments such as Hyperbaric Oxygen Therapy (HBOT), Laser Therapy, and Extracorporeal Shockwave Therapy (ESWT) to help you manage symptoms, promote healing, and potentially reverse some of the damage caused by osteonecrosis. In this article, we will explain the pathology of osteonecrosis, the stages of osteonecrosis and how our therapies work together to provide you relief.
Osteonecrosis (Avascular Necrosis) Symptoms, Stages & Causes
The hip joint is the most commonly affected area, though osteonecrosis can also occur in other bones, such as the shoulder, knee, and ankle. When the blood flow to the bone is reduced or stopped, the bone tissue begins to break down and collapse, leading to pain, inflammation, and loss of function. The condition often develops gradually, and in its early stages, symptoms may be mild or even nonexistent. However, without proper intervention, osteonecrosis can lead to permanent joint damage and disability.
Four Stages of Osteonecrosis
Reproduced and adapted from Beaule PE, Amstutz, HC: Management of ficat stage III and IV osteonecrosis of the hip. J Amer Acad Orthop Surg 2004; 12: 96-105.
- Stage 1: Early changes with no visible abnormalities on X-rays but detectable via MRI. Symptoms are minimal or absent.
- Stage 2: Bone structure begins to change, with sclerosis or cyst formation visible on imaging. Pain typically starts.
- Stage 3: Subchondral collapse (“crescent sign”) appears, indicating severe bone weakening.
- Stage 4: Advanced joint degeneration with cartilage loss and osteoarthritis.
Pathology of Osteonecrosis: Osteonecrosis typically occurs when the blood vessels that supply the bone with oxygen and nutrients become damaged or blocked. This can happen due to trauma (e.g., fractures or dislocations), prolonged use of corticosteroid medications, alcohol use, certain medical conditions (such as sickle cell disease or lupus), or radiation therapy. When the blood supply is interrupted, the bone cells (osteocytes) begin to die, leading to a cascade of events that weaken the bone. Over time, the affected bone can become brittle and collapse, resulting in joint pain and dysfunction.
How Hyperbaric Oxygen Therapy (HBOT) Helps Treat Osteonecrosis
HBOT has been shown to be beneficial in early stages (1 and 2). However, when combined with ESWT (which is effective in stages 1-3) & laser therapy, the synergy generates better outcomes. The HBO promotes oxygenation, reduces ischemia, and enhances bone repair. It increases oxygenation to ischemic bone tissue, which may reduce pain, swelling, and further bone damage by promoting angiogenesis (new blood vessels) and enhancing the activity of bone-forming cells (osteoblasts). Hyperbaric Oxygen Therapy involves breathing pure oxygen in a pressurized environment. This treatment increases the amount of oxygen that can dissolve into the bloodstream, allowing oxygen to reach areas of the body that are lacking sufficient blood supply, such as the bone tissue affected by osteonecrosis.
Scientific Validation of HBOT for Osteonecrosis
Several scientific studies have explored the efficacy of HBOT for treating osteonecrosis. A study published in the Journal of Bone and Joint Surgery found that “HBOT significantly improves the clinical outcome of patients with early-stage osteonecrosis of the hip” (Thomson et al., 2015).
Paderno, E., Zanon, V., Vezzani, G., Giacon, T. A., Bernasek, T. L., Camporesi, E. M., & Bosco, G. (2021). Evidence-Supported HBO Therapy in Femoral Head Necrosis: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health, 18(6), 2888.
https://www.mdpi.com/1660-4601/18/6/2888
Another research article in the Osteoarthritis and Cartilage Journal noted that “HBOT can help reduce pain and improve joint function in patients with osteonecrosis, particularly when combined with other therapies” (Ginsberg et al., 2018). These studies highlight the potential of HBOT to slow the progression of osteonecrosis and improve the overall quality of life for patients.
Bosco, G., Vezzani, G., Sposta, S. M., Rizzato, A., Enten, G., Malacrida, S., Quartesan, S., Vezzoli, A., & Camporesi, E. (2018). Hyperbaric oxygen therapy ameliorates osteonecrosis in patients by modulating inflammation and oxidative stress. Journal of Enzyme Inhibition and Medicinal Chemistry, 33(1), 1501. https://doi.org/10.1080/14756366.2018.1485149
Laser Therapy: In addition to HBOT for Osteonecrosis
Laser therapy is another non-invasive treatment we use for people suffering from osteonecrosis. Class IV laser therapy, also known as hot laser therapy, uses specific wavelengths of light to penetrate deep into the tissues and promote healing.
How Class IV Laser Therapy Helps Osteonecrosis:
- Enhancing Microcirculation: By increasing blood flow, laser therapy may mitigate ischemia, which is a key factor in osteonecrosis.
- Stimulating Cellular Repair: Lasers can promote mitochondrial activity and cellular regeneration, aiding in tissue repair.
- Reducing Pain and Inflammation: Laser therapy has demonstrated anti-inflammatory effects, potentially alleviating symptoms associated with osteonecrosis.
Extracorporeal Shockwave Therapy for Osteonecrosis
ESWT has been shown to be effective in stages 1 to 3 by stimulating bone regeneration, reducing pain, and delaying progression. All of the therapies we do are less effective once joint collapse and arthritis (stage 4) are present.
How Extracorporeal Shockwave Therapy Helps Osteonecrosis:
- Pain Relief: ESWT can help relieve the chronic pain associated with osteonecrosis by stimulating the production of Endorphines which interact with opioid receptors and reducing levels of substance P (A neuropeptide involved in pain transmission and inflammation)
- Enhanced Healing: The shockwaves promote the formation of new blood vessels and stimulate the regeneration of bone tissue. This can help to slow down or even reverse the damage caused by osteonecrosis. ESWT stimulates bone morphogenic proteins (BMPs) which contribute to bone and soft tissue repair, indirectly reducing pain caused by structural damage.
- Improved Function: By reducing pain and enhancing healing, ESWT can improve joint mobility and function, allowing you to return to your daily activities more quickly.
A Multi-Therapy Approach for Optimal Results for Osteonecrosis
For people suffering from osteonecrosis, a combination of HBOT, laser therapy, and ESWT can offer the best chance for improving symptoms and healing. While people’s results may vary, many people report a significant reduction in pain, improved mobility, and a better overall quality of life following a course of treatment. This is followed up with a post-MRI to make sure the bone is regrowing or has, at least, stopped its necrotic progression.
Recommended Treatment Plan: For optimal results, we typically recommend 20-40 sessions of Hyperbaric Oxygen Therapy. These sessions are generally conducted 4-5 times per week, depending on the severity of your condition. Laser therapy and ESWT can be incorporated into your treatment plan, with 2-3 sessions of laser therapy per week and 1-2 ESWT treatments per week. Depending on your response to treatment, your care plan may be adjusted to ensure the best possible outcome.
Take Control of Your Osteonecrosis Treatment Today
If you are suffering from osteonecrosis, you don’t have to live with the pain, fear and disability any longer. At Dr. Adam Fields’ office in Los Gatos, California we offer comprehensive treatment plans that include Hyperbaric Oxygen Therapy (HBOT), Laser Therapy, Extracorporeal Shockwave Therapy (ESWT) and even joint mobilization if needed.
We invite you to schedule a consultation with us to discuss how these innovative treatments can help you manage osteonecrosis and regain your mobility. Whether you’re in the early stages or have been dealing with this condition for years, we are here to help you on your healing journey.