Introduction
Chronic osteomyelitis represents a persistent and debilitating condition within orthopaedic care. While the bone has unique anatomical and vascular characteristics, Hyperbaric Oxygen Therapy has been used to augment traditional treatments.
The Pathophysiology of Chronic Osteomyelitis
Osteomyelitis is characterised by inflammation and infection of the bone, often resulting in necrosis, sinus tract formation, and systemic symptoms. Chronic forms involve biofilm-producing bacteria that are notoriously resistant to antibiotics. Typically, healing is slow, and recurrence is common.
Traditional interventions include resection of necrotic bone, soft tissue flaps, and intravenous antibiotics. However, these may not restore normal bone physiology, particularly in patients with compromised immune function or diabetes.
How HBOT Enhances Bone Healing
HBOT enhances tissue oxygenation by delivering 100% oxygen at 2–3 times normal atmospheric pressure. This elevation in oxygen tension promotes a cascade of biological processes essential for recovery:
- Angiogenesis: Formation of new blood vessels improves local perfusion in poorly vascularised bone.
- Osteogenesis: Oxygen-rich environments stimulate osteoblast activity and collagen synthesis.
- Antibacterial Effects: Increased oxygen supports leukocyte function and disrupts bacterial biofilms (Slater & Bachmid, 2023).
- Enhanced Antibiotic Efficacy: Some antibiotics, such as aminoglycosides, perform better in oxygen-rich environments.
Clinical Benefits and Case Evidence
Emerging clinical cases report reduced recurrence rates and faster resolution of infection when HBOT is used adjunctively. In patients with post-traumatic osteomyelitis of the distal tibia, HBOT helped avoid amputation and improved quality of life by reducing pain and restoring mobility. Outcomes were especially positive when HBOT was introduced early in the treatment cycle and combined with surgical debridement and systemic antibiotics.
Conclusion
Hyperbaric Oxygen Therapy represents a promising adjunct in the treatment of chronic distal tibial osteomyelitis. By creating an oxygen-rich environment that favours immune function and tissue regeneration, HBOT addresses the root pathophysiology of infection and bone necrosis. Incorporating HBOT into treatment pathways may help orthopaedic patients achieve more complete and sustainable recoveries.
References
- Slater, G., & Bachmid, Z. (2023). Application of Hyperbaric Oxygen Therapy in Chronic Distal Tibial Osteomyelitis in Severe Extremity Trauma. Journal of Regenerative Biology and Medicine, 5(5), 311–316. https://doi.org/10.37191/Mapsci-2582-385X-5(5)-139
