RevitalizeMe
Hyperbaric Oxygen & Wound Care
3200 Cabaret Trail S., Suite 3 | Saginaw, MI 48603
(989) 320-4434 | HyperbaricWoundCare.com
(989) 320-4434 | HyperbaricWoundCare.com
Clinical Evidence Summary
Avascular Necrosis & HBOT
UHMS Recognized
| Most Major Private Payors
70%
Patients show pain reduction after HBOT course
Camporesi et al., J Arthroplasty 2010
Stage I–II
Optimal intervention window — before femoral head collapse
Reis et al., JBJS Br 2003
30–40
HBOT sessions in standard protocol for AVN
UHMS Indications Manual, 14th Ed.
Clinical Overview
Avascular necrosis (AVN), or osteonecrosis, results from disrupted blood supply to bone — most commonly affecting the femoral head, humeral head, and knee. Without intervention, 70–80% of untreated Stage II lesions progress to femoral head collapse, requiring total joint replacement. HBOT promotes angiogenesis, reduces bone marrow edema, and stimulates osteogenic repair — offering a non-surgical option to slow or halt disease progression in early-stage AVN.
Key Published Evidence
Journal of Arthroplasty — Controlled Study
Camporesi et al. evaluated HBOT in femoral head osteonecrosis and found significant reductions in pain and improved functional scores in HBOT-treated patients vs. controls, with MRI evidence of reduced marrow edema following treatment.
Camporesi EM, et al. J Arthroplasty. 2010;25(3):459–461.
Journal of Bone & Joint Surgery (Br) — Prospective Study
Reis et al. studied HBOT as the sole treatment in Stage I AVN of the femoral head. At 36 months, patients treated with HBOT showed significantly greater clinical and radiographic improvement compared to core decompression controls.
Reis ND, et al. J Bone Joint Surg Br. 2003;85(3):371–375.
UHMS Recognition
The Undersea and Hyperbaric Medical Society (UHMS) recognizes AVN as an approved HBOT indication. Most major commercial payors provide coverage. Not a Medicare/Medicaid-covered indication — private insurance verification required prior to initiation.
UHMS Hyperbaric Oxygen Therapy Indications, 14th Edition.
How HBOT Works
1
Reduces bone marrow edema by decreasing intraosseous pressure
2
Stimulates angiogenesis — restores microvascular supply to ischemic bone
3
Promotes osteoblast activity and inhibits osteoclast-driven resorption
4
Reduces inflammatory cytokines contributing to ongoing necrosis
Ideal Referral Candidate
Stage I or II AVN — before cortical collapse occurs
Femoral head, humeral head, or knee osteonecrosis
Steroid-induced, idiopathic, or post-traumatic AVN
Patients seeking to delay or avoid joint replacement surgery
Post-core decompression — HBOT as adjunct to surgery
Standard HBOT Protocol
Pressure
2.4 ATA
Duration
90 min/session
Sessions
30–40 dives
Coverage
Private payors