Hyperbaric Oxygen Therapy as adjunct has emerging role in Orthopaedics

Hyperbaric oxygen therapy (HBOT) has emerged as an adjunct treatment modality in various orthopedic and rheumatological conditions. Undersea and Hyperbaric Medical Society (UHMS) defined the minimum number of HBOT cycles, dose, and frequency for various diseases. UHMS laid the 14 absolute indications for HBOT.

The article by Madhan Jeyaraman et al was published in “Indian Journal of Orthopaedics.” It deals with the mechanism of actions of HBOT and evidence of various musculoskeletal disorders where HBOT was utilized to accelerate the healing process of the diseases.

The review literature search was conducted by using PubMed, SCOPUS, and other database of medical journals for identifying, reviewing, and evaluating the published clinical trial data, research study, and review articles for the use of HBOT in musculoskeletal disorders.

Hyperbaric oxygen acts by two primary mechanisms, namely, hyperoxygenation and decreased bubble size.

The secondary mechanisms by which HBO acts are:

(a) Vasoconstriction (osteonecrosis, crush injury/compartment syndrome, and thermal burns).

(b) Neovasculogenesis (non-healing ulcers and wounds, compromised grafts and fl aps, and radiation-induced injury).

(c) Migration and proliferation of fibroblasts (non-healing ulcers and wounds and radiation-induced injury).

(d) Oxidative killing by leukocytes (refractory osteomyelitis and necrotizing soft tissue infections).

(e) Inhibition of toxins (clostridial myonecrosis).

(f) Antibiotic synergy (refractory osteomyelitis and necrotizing soft tissue infections).

(g) Reduction of intravascular leukocyte adherence (crush injury/compartment syndrome).

(h) Lipid peroxidation (CO poisoning and crush injury/ compartment syndrome).

• Various clinical researchers documented cellular and biochemical advantages of HBOT which possess allodynic effects, anti-inflammatory, and prooxygenatory effects in patients with musculoskeletal conditions.

• Studies on the usage of HBOT in avascular necrosis and wound healing provide a platform for exploring the plausible uses of HBOT in other musculoskeletal conditions.

• Literature evidence states the complications associated with HBOT therapy. Claustrophobia and middle ear barotrauma (MEB) are the two most common complications which occur during either monoplace or multiplace chamber HBOT compression.

The authors concluded that – “The available literature provides a bird’s eye view of HBOT application in various musculoskeletal disorders. The standardization and optimization need to be performed in terms of dose, frequency, number of sessions, safety, and efficacy of existing protocols of HBOT in musculoskeletal conditions. With the significant implications of HBOT, clinical applications have to be explored in the future.”

Further reading:

Hyperbaric Oxygen Therapy in Orthopaedics: An Adjunct Therapy with an Emerging Role

Madhan Jeyaraman, Abdus Sami et al

Indian Journal of Orthopaedics (2023) 57:748–761

https://doi.org/10.1007/s43465-023-00837-2