Bone marrow edema syndrome/transient osteoporosis of the hip
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Transient osteoporosis of hip (TOH) is considered as a rare, benign and self-limited condition that affects middle aged men and women in the third trimester of pregnancy or the immediate postpartum period and is characterized by demineralization, bone marrow edema (BME) of the proximal femur and eventually complete resolution after several months.

The treatment modalities for the management of TOH includes conservative treatment with restriction of weight bearing activities, pharmacological agents,extracorporeal shock wave therapy, hyperbaric oxygen therapy (HBOT) and surgical intervention using core decompression.

HBOT is an intriguing method in which the individual is subjected to 100% oxygen inhalation inside a chamber where the pressure is adjusted to greater than 1 atm absolute (ATA).The HBOT is applied inside a compression vessels called the hyperbaric chambers which may be high pressure multi-place chambers, high pressure mono-place chambers or low pressure mono-place chambers. In the mono-place chambers only a single patient is allowed while in the multi-place chambers, multiple patients can be exposed to the high levels of oxygen which is delivered through face masks, hoods or even endotracheal tubes.

Exposure to high oxygen pressure causes toxicity, which is directly relative to the exposure time . Since patients undergoing HBOT are not been exposed for a long period of time, this has the effect of activating antioxidant mechanisms that could reverse the damage that can be caused by the action of ROS, thus providing a protective role.

Furthermore, the use of HBOT has absolute contraindications which include pneumothorax, restrictive respiratory disorders, and patients receiving chemotherapy. Therefore, all patients should be carefully subjected into pre-exposure examination to exclude patients with such conditions.

In the early stages of AVN, HBOT helps to provide high oxygen pressures (oxygenation) in the hypoxic tissues, reduces BME, and induces angiogenesis. The reduction of intraosseous pressure is associated with pain relief and venous drainage restoration, which therefore improves microcirculation. Bone resorption, revascularization and osteogenesis are the late effects of HBOT.

Therefore, the application of HBOT in off-label use in patients with TOH has been attempted with beneficial effects by reducing intraosseous edema with vasoconstriction and increasing bone repair.Consequently, HBOT has been utilized as a potential treatment in those patients suffering from TOH.

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