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Review

Evidence-Supported HBO Therapy in Femoral Head Necrosis: A Systematic Review and Meta-Analysis

by
Emma Paderno
1,2,
Vincenzo Zanon
1,2,*,
Giuliano Vezzani
1,
Tommaso Antonio Giacon
1,*,
Thomas L. Bernasek
3,
Enrico M. Camporesi
4 and
Gerardo Bosco
1
1
Environmental and Respiratory Physiology Lab and II Level Master in Diving and Hyperbaric Medicine, Department of Biomedical Sciences, University of Padova, 35122 Padova, Italy
2
DHMU at ICCB, Istituti Ospedalieri Bresciani, GSD—University and Research Hospitals, 25128 Brescia, Italy
3
Adult Reconstruction, Florida Orthopaedic Institute, Tampa, FL 33625, USA
4
TEAM Health Research Institute, Tampa, FL 33606, USA
*
Authors to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2021, 18(6), 2888; https://doi.org/10.3390/ijerph18062888
Submission received: 15 February 2021 / Revised: 8 March 2021 / Accepted: 10 March 2021 / Published: 12 March 2021
(This article belongs to the Special Issue Environmental Physiology and Medicine: Diving and Hyperbaric Exposure)
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Abstract

Although many studies have shown that hyperbaric oxygen (HBO) therapy can significantly improve symptoms and quality of life of patients affected by femoral head necrosis, this therapy is not worldwide approved yet. This meta-analysis was performed to evaluate its clinical effect. Relevant studies published before May 2020 were systematically searched using terms related to HBO and femoral head necrosis. Fixed and random-effects models were used to estimate the odds ratio (OR) with 95% confidence intervals (CI). Subgroup analyses and publication bias tests were carried out to explore potential study heterogeneity and bias. Ten studies involving 353 controls and 368 HBO-treated cases were included, most of which were conducted on Asian population. The clinical effect in the HBO therapy group was 3.84 times higher than in the control group (OR = 3.84, 95% CI (2.10, 7.02), p < 0.00001). Subgroup analyses showed that the clinical effect of HBO therapy was statistically significant in the Asian subpopulation which represented most of the subjects (OR = 3.53, 95% CI (1.87, 6.64), p < 0.00001), but not in the non-Asian subpopulation, probably because of insufficient numerosity (OR = 7.41, 95% CI (0.73, 75.71), p = 0.09). The results of this meta-analysis suggest that patients with femoral head necrosis treated with HBO therapy can achieve a significant clinical improvement.
Keywords: femoral head necrosis; hyperbaric oxygen therapy; necrosis; osteonecrosis; oxygen; microcirculation; pain femoral head necrosis; hyperbaric oxygen therapy; necrosis; osteonecrosis; oxygen; microcirculation; pain

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MDPI and ACS Style

Paderno, E.; Zanon, V.; Vezzani, G.; Giacon, T.A.; Bernasek, T.L.; Camporesi, E.M.; Bosco, G. Evidence-Supported HBO Therapy in Femoral Head Necrosis: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2021, 18, 2888. https://doi.org/10.3390/ijerph18062888

AMA Style

Paderno E, Zanon V, Vezzani G, Giacon TA, Bernasek TL, Camporesi EM, Bosco G. Evidence-Supported HBO Therapy in Femoral Head Necrosis: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 2021; 18(6):2888. https://doi.org/10.3390/ijerph18062888

Chicago/Turabian Style

Paderno, Emma, Vincenzo Zanon, Giuliano Vezzani, Tommaso Antonio Giacon, Thomas L. Bernasek, Enrico M. Camporesi, and Gerardo Bosco. 2021. "Evidence-Supported HBO Therapy in Femoral Head Necrosis: A Systematic Review and Meta-Analysis" International Journal of Environmental Research and Public Health 18, no. 6: 2888. https://doi.org/10.3390/ijerph18062888

APA Style

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://doi.org/10.3390/ijerph18062888

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