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Bone infection - osteomyelitis

Bone Infection or Osteomyelitis

Osteomyelitis is septic inflammatory bone disease – that can be due to direct trauma, surgery or infection spread by blood.

Bacterial infection reduces the blood supply and oxygen delivery to the bone (ischemia and hypoxia, respectively) which interfere with bone healing. Hypoxia reduces local perfusion, as well as function of white blood cell in bacterial elimination, bone cells activity in removal of dead infected bone and formation of a new bone (osteoclast and osteoblast activity). Finally, hypoxia limits antibiotics therapeutic function to penetrate pus and inactivate microorganisms.

Hyperbaric oxygen therapy effectively corrects tissue hypoxia and improves blood flow and bone metabolism for faster bone healing.

Medical Hyperbaric Oxygen Therapy (HBO) is the most efficient adjunctive therapy to surgery and antibiotic therapy to correct for tissue hypoxia and ischemia and facilitate bone healing.

Traditional therapies include surgery for removal of the necrotic bone (debridment) and high doses of antibiotics.

The most effective health care is preventive care!

Hyperbaric Oxygen is routinely used in dental surgery to increase
the success of bone grafting and implants.

Clinical application of Hyperbaric Oxygen

  • Oxygen under pressure is considered a “natural antibiotic” having bacteriostatic and bacteriocidic properties
  • Hyperbaric oxygen enhances antibiotics activity and reduces their side effect
  • Hyperbaric oxygen prepares the bone for grafting and speeds up post surgical recovery
  • Hyperbaric oxygen facilitates  new bone formation (osteogenesis)  and removal of necrotic bone (osteoclast/ osteoblast)
  • Hyperbaric oxygen provides adequate oxygen for new vessels formation for overall improved microcirculation
  • Hyperbaric oxygen not only speeds up the bone recovery but improves the bone metabolism and bone density
  • Hyperbaric oxygen facilitates the release the stem cells by the bone marrow for further overall long lasting benefits
  • Hyperbaric oxygen reduces pain and strengthens the body’s defense immune system

The Undersea and Hyperbaric Medical Society (UHMS) recognizes refractory osteomyelitis as  approved indication for hyperbaric oxygen (HBO) therapy medical reimbursement.

Further reading:
  1. Chen-Yin Chen, et al: Adjuvant Hyperbaric Oxygen Therapy in the Treatment of Hemodialysis Patients with Chronic Osteomyelitis. Renal Failure, 30:233–237, 2008
  2. Adams KR, Mader JT: Aminoglycoside potentiation with adjunctive hyperbaric oxygen therapy in experimental Pseudomonas Aeruginosa osteomyelitis. Undersea Biomed Res; 14(suppl): 37, 1987
  3. Adams KR, Sutton TE, Mader JT: In vitro potentiation of tobramycin under hyperoxic conditions. Undersea Biomed Res 14 (suppl): 37, 1987
  4. Aitasalo K, Niinikoski J, Grenman R, Virulainen E. A modified protocul for early treatment of osteomyelitis and Osteoradionecrosis of the mandible. Head Neck; 20(5): 411-7, Aug 1998
  5. Andel H, Felfernig M, Andel D, Blaicher W, Schramm W: Hyperbaric oxygen therapy in osteomyelitis. Anaesthesia; 53 Suppl 2:68-9, Review, May 1998
  6. Babior BM: Oxygen-dependent killing by phagocytes. New Eng J Med; 298:659-668, 1978
  7. Berg E, Barth E, Clarke D, Douley L: The use of adjunctive hyperbaric oxygen in treatment of orthopedic infections and problem wounds: an overview and case reports. J Invest Surg; 2(4): 409-21, Review, 1989
  8. Calhoun JH, Cobos JA, Mader JT: Does hyperbaric oxygen have a place in the treatment of osteomyelitis. Orthopedic Clinics of North America; 22(3):467-471, 1991
  9. Chen CY, Lee SS, Chan YS, Yen CY, Chao EK, Ueng SW: Chronic refractory tibia osteomyelitis treated with adjuvant hyperbaric oxygen: a preliminary report. Changgeng Yi Xue Za Zhi; 21(2): 165-71, Jun 1998
  10. Davis JC: Refractory osteomyelitis. Problem Wounds, The Rule of Oxygen; Chpt. 4 Elsevier Science Publ Co; New York1988
  11. Davis JC, Heckman JD, Delee JC, Buckwuld FJ: Chronic non-hematogenous osteomyelitis treated with adjuvant hyperbaric oxygen. J Bone Joint Surg; 68: 1210-1217, 1986
  12. Eltorai I, Hart GB, Strauss MB: Osteomyelitis in the spinal cord injured: a review and a preliminary report on the use of hyperbaric oxygen therapy. Paraplegia; 22(1):17-24 Feb 1984
  13. Esterhai JL, Pisarello J, Brighton CT, Heppenstall RB, Gellman H, Guldstein G: Adjunctive hyperbaric oxygen therapy in the treatment of chronic refractory osteomyelitis. J Trauma; 27(7): 763-8, Jul 1987
  14. Evans BE, Jacobson JH, Peirce EC, Friedman EW, Schwartz AE: Chronic osteomyelitis of mandible. NY State J Med; 76(6): 966-967, 1976
  15. Hunt KT, Linsey M, Grislis G, Sonne M, Jawetz E: the effect of differing ambient oxygen tension on wound infection. Annals of surgery; 181 (1):35-39, Jan 1975
  16. Jamil MU, Eckardt A, Franko W: Hyperbaric oxygen therapy. Clinical use in treatment of osteomyelitis, osteoradionecrosis and reconstructive surgery of the irradiated mandible. Mund KieferGesichtschir; 4(5): 320-3, Sep. 2000
  17. Jain KK: Hyperbaric Oxygen Therapy in Infection. Hyperbaric Medicine; 13:189–211, 1999
  18. Jones HP: The rule of oxygen and its derivatives in bacterial killing and inflammation. In Gottlieb SF, Longmuir IS., and Totter JR. (eds): Oxygen: An In-Depth Study of its Pathophysiulogy. Bethesda, Maryland: Undersea Medical Society; pp. 493-516, 1984
  19. Keck PE, Gottlieb SF, Conley J: Interaction of increased pressures of oxygen and sulfonamides on the in vitro and in vivo growth of pathogenic bacteria. Undersea Biomed Res 7:95-106, 1980
  20. Kindwall EP: The use of Hyperbaric Oxygen in Treatment of Osteomyelitis Hyperbaric Medical Practice; 23:604 –613, 1999
  21. Knighton DR, Halliday B, Hunt TK: Oxygen a an antibiotics: The effect of inspired Oxygen on infection. Arch Surg; 119; 199-204, Feb 1984
  22. Leonov VM: The necessity and principles of oxygen therapy in human infection Terapevticheskii Arkhiv; 34 (2): 101, 1962
  23. Mader JT, Adams KR, Wallace WR, Calhoun JH: Hyperbaric oxygen as adjunctive therapy for osteomyelitis. Infect Dis Clin North Am; 4(3): 433-40, Review, Sep 1990
  24. Mainous EG, Boyne PJ, Hart GB: Hyperbaric oxygen treatment of mandibular osteomyelitis: Report of three cases. J Am Dent Assoc; 87: 1426-1430, 1973
  25. Maynor ML, Moon RE, Camporesi EM, Fawcett TA, Fracica PJ, Norvell HC, Levin LS: Chronic osteomyelitis of the tibia: treatment with hyperbaric oxygen and autogenous microsurgical muscle transplantation. J South Orthop Assoc; 7(1): 43-57, 1998
  26. Morrey BF, Dunn JM, Heimbach RD, Davis J: Hyperbaric oxygen and chronic osteomyelitis. Clin Orthop; 144:121-127, 1979
  27. Norden CW, Kleti E: Experimental osteomyelitis caused by Pseudomonas aeruginosa. J Infect Dis; 141:71-75, 1980
  28. Waisman D, Shupak A, Weisz G, Melamed Y: Hyperbaric oxygen therapy in the pediatric patient: the experience of the Israel Naval Medical Institute. Pediatrics; 102(5): E53, Nov 1998
  29. Schweitzer VG: Hyperbaric oxygen management of chronic staphylococcal osteomyelitis of the temporal bone. Am J Otul; 11(5): 347-53, Sep 1990

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Hip and knee replacement recovery, 
Dr. Kallesoe, MD Orthopedic surgeon, Denmark

"Hyperbaric oxygen therapy is amazing at improving implant acceptance and infection control. It speeds up recovery and is definitely recommend to be used both pre and post-operatively for any surgery."  

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 Information contained on this site is intended for general consumer understanding and education. It should not be used as a substitute for any medical professional opinion, advice or prescribed medication nor should it serve as diagnosis or treatment of health problems.