Bone Deseases

Aseptic bone necrosis
(e.g. Femoral head avascular necrosis and Morbus Ahlbäck disease)
Aseptic bone necrosis, osteochondrosis or osteomyelitis are mostly spontaneously occurring disorders of bone or cartilage deterioration, often at the hip joint of the femur, on the knee joint or on the tibial plateau (Morbus Ahlbäck).

Pathophysiology (original causes)

Based on current knowledge, this is a multifactorial event, in which disruption of the local blood circulation as well as genetic factors play a role. Risk factors include: accident, coagulation disorders, obesity, pregnancy, cortisone medication, longterm damage of workers exposed to overpressure or from diving, neurological diseases, diabetes or alcoholism.

First symptoms are sudden pain felt in the affected joint area, or under loaded pressure (e.g. going upstairs) as well as at rest, typically at night. At a later stage, movement is restricted.

The stages of Morbus Ahlbäck disease

The disease is divided into stages according to ARCO:

  • Stage 1 shows slight changes in the form of a bone marrow oedema, which can be seen only in an MRI.
  • Stage 2 presents a more pronounced picture in the MRI with areas of bone marrow oedema and sclerosis, and in an X-ray image there are significant areas of compression.
  • Stage 3 presents signs of bone resorption and subchondral fractures.
  • Stage 4 shows there is clearly visible cartilage and bone changes in all examination methods.

Efficacy of HBO therapy

HBO therapy is a form of treatment whereby the patients inhale medically pure hyperbaric oxygen (HBO = hyperbaric oxygenation). In a hermetically sealed chamber, pressure is increased from 1.5 - 3 times the normal atmospheric pressure. Normally, the oxygen in the air binds itself to the red blood cells and is transported from the blood stream to the tissues. The diseased or injured organism can only maintain this oxygen supply to a limited extent and the oxygen is unable to penetrate the tissues sufficiently. Under the conditions of HBO therapy, the oxygen is absorbed by the blood plasma, as well as by the red blood corpuscles.  As a result, the penetration depth of the oxygen into the tissue is increased by up to 4 times, and the tissue which has been damaged under normal conditions is again supplied with sufficient oxygen.

In the case of a reduced blood circulation in aseptic bone necrosis the following therapeutic effects can be expected:

• Reduction of an existing bone oedema by vasoconstriction. New blood vessels  are formed.
• Connective tissue-forming cells are activated and connective tissue fibres are produced in greater quantities.
• Stimulation of the cells responsible for bone reabsorption and bone building lead to bone regeneration.

The individual therapy

Together with your doctor, the pressure chamber doctor will work out a treatment programme specifically for your medical conditions. Doctors and patient work “hand in hand”. The patient should comply with any lifestyle and medication recommendations by the treating physician. The HBO therapy ensures wound healing with the enrichment of oxygen in the tissue. 

The different stages affect the type of treatment needed.

  • In Stage 1 the affected joint is relieved. This can be done by e.g. an increase in the height of the shoe edge or a suitable walking apparatus. The process needs to be closely monitored by the physician.
  • In Stage 2 alleviation is no longer enough. It is here that hyperbaric oxygen therapy (HBO) can be successfully deployed in many cases. The increased oxygen concentration in the tissue reduces oedema, and aids vascular regeneration. Cells responsible for bone resorption and bone building (osteoclasts and osteoblasts) are activated and are able to rebuild the damaged area. HBOT should be used in conjunction with Physiotherapy.
  • In Stage 3 already shows slight cartilage/bone deterioration and in some cases an operation is necessary. However, HBOT can improve therapeutic success as an additional measure, by supporting the formation of new blood vessels and stimulating bone regeneration. As the sole treatment, a full recovery can be achieved in ca. 60% of all treated patients. In the remainder of the cases, the joint surfaces can be preserved through operative measures. Symptomatically, pain treatment should also be implemented with anti-inflammatory analgesics (antiphlogistics) in all three stages.
  • In Stage 4  only bone grafting, a joint or partial joint replacement will restore walking ability.

Reimbursement of costs

Private health insurance companies and the benefits office make their decisions according to individual requirements of the insured person.  As a rule the costs are met. They are based on the statutory scale of medical fees for physicians (GOÄ).
Statutory health insurance companies pay for the treatment only in exceptional individual cases. Before each treatment, we prepare a detailed cost estimate. Treatment is usually started after cost clarification and medical examinations have been carried out.


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