Hyperbaric Oxygen Therapy For Orthopaedic Infection.
1Executive director, Orthopedic surgeon and hyperbaric physician, Kawashima Orthopedic Hospital, Japan
Mahito Kawashima, Masayuki Kawashima, Hiroaki Tamura, Ikufumi Nagayoshi, Katsuhiro Takao, Takashi Yamaguchi, Kenji Miyata
Kawashima Orthopaedic Hospital, 17 Miyabu, Nakatsu-shi, Oita-ken, 871-0012, Japan
Osteomyelitis and pyogenic arthritis are bacterial infectious diseases in bones/joints which sometimes become refractory and long-term treatments may be necessary. Also, gas gangrene and necrotizing fasciitis are bacterial infections in the soft tissue. It is a dangerous infection which is high risk and turns into a fatal condition and limb amputation. We started using Hyperbaric Oxygen Therapy (HBO) in 1981 and positively apply it in our orthopaedic treatments. We will discuss various treatment cases and results using HBO.
We treated 22 necrotizing fasciitis cases. The results were as follows: cure after necrotomy and/or skin graft without amputation in 10 cases. 3 cases almost cured, minor amputation performed in 4 cases, major amputation performed in 2 cases. 4 cases were transferred to another general hospital due to their general condition worsening. Sixty-four gas gangrene cases were dealt with HBO and other treatments. The results were as follows: 33 cases were cured and their limbs were salvaged, 9 cases were amputated on the foot or toes(Syme amputation), 15 cases were A-K/B-K amputation, 3 cases died and 4 cases were transferred to other facilities. We performed HBO for 60 minutes at 2.8 ATA (atmosphere absolute) against fatal infectious diseases such as necrotizing fasciitis or gas gangrene. Depending on the patient’s condition, 2 sessions of HBO per day are an effective measure.
We treated 822 osteomyelitis cases and 171 pyogenic arthritis cases with HBO. We performed HBO at 2.0ATA for 60 minutes daily for from 30 to 60 sessions. Many cases finished treatments conservatively, but serious cases needed surgical operations which consisted of washing the bone marrow/internal joints continuously: “closed irrigation therapy”. Treatment results of osteomyelitis are:- 533 cases (64.8%) were treated without surgical operations, 437 cases were good. 289 cases (35.2%) were treated with a surgical operation in addition to HBO, 230 cases were good and the other 15 cases (5.2%) were not good enough. 103 out of 171 pyogenic arthritic cases treated conservatively. 101 cases (98.1%) were good and the other 2 cases were not good enough. 68 pyogenic arthritic cases treated with surgical operations in addition to HBO. 67 cases (98.5%) were good and the other case was not good enough.
The effect of HBO for infectious diseases are caused by the oxygen toxicity (oxidative killing) and it increases the leukocyte activity. In addition to it, HBO increases wound healing and enhance the use of antibiotics. HBO is the one of the most useful conservative methods for orthopaedic treatments.