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Meta-Analysis
. 2021 Mar 12;18(6):2888.
doi: 10.3390/ijerph18062888.

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

Emma Paderno  1   2 , Vincenzo Zanon  1   2 , Giuliano Vezzani  1 , Tommaso Antonio Giacon  1 , Thomas L Bernasek  3 , Enrico M Camporesi  4 , Gerardo Bosco  1
Affiliations
Meta-Analysis

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

Emma Paderno et al. Int J Environ Res Public Health. .

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; microcirculation; necrosis; osteonecrosis; oxygen; pain.

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Conflict of interest statement

The authors declare no conflicts of interest exist with this submission.

Figures

Figure 1
Figure 1
Flowchart of the selection strategy and inclusion/exclusion criteria used in the current meta-analysis.
Figure 2
Figure 2
Characteristics and assessment of the methodological quality of trials included in the meta-analysis. Events = cases in which hyperbaric oxygen therapy (HBOT) was effective.
Figure 3
Figure 3
Evidence-supported HBO therapy in the treatment of femoral head necrosis. CI: confidence interval. M–H: Metropolis–Hastings. Events = cases in which HBOT was effective.
Figure 4
Figure 4
Evidence-supported HBO therapy in the treatment of femoral head necrosis (subgroup analysis). CI: confidence interval. M–H: Metropolis–Hastings. Events = cases in which HBOT was effective.
Figure 5
Figure 5
Funnel plot of publication bias. OR: odds ratio. SE: standard error.
Figure 6
Figure 6
Funnel plot of publication bias (subgroup analysis). OR: odds ratio. SE: standard error.
See this image and copyright information in PMC

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