{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T10:31:37Z","timestamp":1789468297167,"version":"build-2803163510"},"reference-count":123,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2021,3,12]],"date-time":"2021-03-12T00:00:00Z","timestamp":1615507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>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 &lt; 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 &lt; 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.<\/jats:p>","DOI":"10.3390\/ijerph18062888","type":"journal-article","created":{"date-parts":[[2021,3,11]],"date-time":"2021-03-11T22:38:23Z","timestamp":1615502303000},"page":"2888","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Evidence-Supported HBO Therapy in Femoral Head Necrosis: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9248-3497","authenticated-orcid":false,"given":"Emma","family":"Paderno","sequence":"first","affiliation":[{"name":"Environmental and Respiratory Physiology Lab and II Level Master in Diving and Hyperbaric Medicine, Department of Biomedical Sciences, University of Padova, 35122 Padova, Italy"},{"name":"DHMU at ICCB, Istituti Ospedalieri Bresciani, GSD\u2014University and Research Hospitals, 25128 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Zanon","sequence":"additional","affiliation":[{"name":"Environmental and Respiratory Physiology Lab and II Level Master in Diving and Hyperbaric Medicine, Department of Biomedical Sciences, University of Padova, 35122 Padova, Italy"},{"name":"DHMU at ICCB, Istituti Ospedalieri Bresciani, GSD\u2014University and Research Hospitals, 25128 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuliano","family":"Vezzani","sequence":"additional","affiliation":[{"name":"Environmental and Respiratory Physiology Lab and II Level Master in Diving and Hyperbaric Medicine, Department of Biomedical Sciences, University of Padova, 35122 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1155-0628","authenticated-orcid":false,"given":"Tommaso Antonio","family":"Giacon","sequence":"additional","affiliation":[{"name":"Environmental and Respiratory Physiology Lab and II Level Master in Diving and Hyperbaric Medicine, Department of Biomedical Sciences, University of Padova, 35122 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4373-9350","authenticated-orcid":false,"given":"Thomas L.","family":"Bernasek","sequence":"additional","affiliation":[{"name":"Adult Reconstruction, Florida Orthopaedic Institute, Tampa, FL 33625, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico M.","family":"Camporesi","sequence":"additional","affiliation":[{"name":"TEAM Health Research Institute, Tampa, FL 33606, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6595-7944","authenticated-orcid":false,"given":"Gerardo","family":"Bosco","sequence":"additional","affiliation":[{"name":"Environmental and Respiratory Physiology Lab and II Level Master in Diving and Hyperbaric Medicine, Department of Biomedical Sciences, University of Padova, 35122 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,3,12]]},"reference":[{"key":"ref_1","unstructured":"Barney, J., Piuzzi, N.S., and Akhondi, H. (2021). Femoral Head Avascular Necrosis. StatPearls [Internet], StatPearls Publishing."},{"key":"ref_2","first-page":"370","article-title":"Epidemiological risk factors for non-traumatic osteonecrosis","volume":"29","author":"Jones","year":"2000","journal-title":"Der Orthop\u00e4de"},{"key":"ref_3","first-page":"60","article-title":"La necrosi della testa del femore","volume":"30","author":"Tecchio","year":"2003","journal-title":"Acta Ortopedica Italica"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"49","DOI":"10.5312\/wjo.v3.i5.49","article-title":"Osteonecrosis of the femoral head: An update in year","volume":"3","author":"Kaushik","year":"2012","journal-title":"World J. Orthop."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"S16","DOI":"10.1016\/S0020-1383(16)30835-X","article-title":"The physiopathology of avascular necrosis of the femoral head: An update","volume":"47","author":"Guerado","year":"2016","journal-title":"Injury"},{"key":"ref_6","first-page":"327","article-title":"Avascular necrosis of the femoral head: Etiology, pathophysiology, classification, and current treatment guidelines","volume":"33","author":"Aldridge","year":"2004","journal-title":"Am. J. Orthop."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2843","DOI":"10.4103\/0366-6999.168017","article-title":"Prevalence of Nontraumatic Osteonecrosis of the Femoral Head and its Associated Risk Factors in the Chinese Population","volume":"128","author":"Zhao","year":"2015","journal-title":"Chin. Med. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1007\/s00198-018-04826-2","article-title":"Epidemiology of osteonecrosis among older adults in Sweden","volume":"30","author":"Bergman","year":"2019","journal-title":"Osteoporos. Int."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1007\/s00198-009-1003-1","article-title":"The epidemiology of osteonecrosis: Findings from the GPRD and THIN databases in the UK","volume":"21","author":"Cooper","year":"2009","journal-title":"Osteoporos. Int."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e020680","DOI":"10.1136\/bmjopen-2017-020680","article-title":"Association of common comorbidities with osteonecrosis: A nationwide population-based case\u2013control study in Denmark","volume":"8","author":"Dima","year":"2018","journal-title":"BMJ Open"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2715","DOI":"10.1007\/s11999-010-1292-x","article-title":"Nationwide Epidemiologic Survey of Idiopathic Osteonecrosis of the Femoral Head","volume":"468","author":"Fukushima","year":"2010","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.1016\/j.arth.2009.05.022","article-title":"Prevalence of Osteonecrosis of the Femoral Head","volume":"24","author":"Kang","year":"2009","journal-title":"J. Arthroplast."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"39","DOI":"10.3928\/01477447-20101123-19","article-title":"Osteonecrosis of the Femoral Head","volume":"34","author":"Babis","year":"2011","journal-title":"Orthopedics"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"590","DOI":"10.5312\/wjo.v6.i8.590","article-title":"Current concepts on osteonecrosis of the femoral head","volume":"6","author":"Gianakos","year":"2015","journal-title":"World J. Orthop."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1604","DOI":"10.2106\/JBJS.O.00071","article-title":"Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today?","volume":"97","author":"Mont","year":"2015","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1053\/sarh.2002.33724b","article-title":"Pathogenesis and natural history of osteonecrosis","volume":"32","author":"Chang","year":"2002","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1007\/s12178-015-9277-8","article-title":"Pathophysiology and risk factors for osteonecrosis","volume":"8","author":"Shah","year":"2015","journal-title":"Curr. Rev. Musculoskelet. Med."},{"key":"ref_18","unstructured":"Callaghan, J.J., Rosenberg, A.G., and Rubash, H.E. (2007). Osteonecrosis: Etiology, natural history, pathophysiology, and diagnosis. The Adult Hip, Lippincott Williams & Wilkins."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1302\/0301-620X.68B4.3733842","article-title":"Death of osteocytes. Electron microscopy after in vitro ischaemia","volume":"68","author":"James","year":"1986","journal-title":"J. Bone Jt. Surgery. Br."},{"key":"ref_20","first-page":"284","article-title":"Nicolas Andry award. The biology of osteonecrosis of the human femoral head and its clinical implications: I. Tissue biology","volume":"138","author":"Glimcher","year":"1979","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_21","first-page":"283","article-title":"The biology of osteonecrosis of the human femoral head and its clinical implications: II. The pathological changes in the femoral head as an organ and in the hip joint","volume":"139","author":"Glimcher","year":"1979","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_22","first-page":"273","article-title":"The biology of osteonecrosis of the human femoral head and its clinical implications. III. Discussion of the etiology and genesis of the pathological sequelae; comments on treatment","volume":"140","author":"Glimcher","year":"1979","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1002\/jor.1100100110","article-title":"Structural consequences of subchondral bone involvement in segmental osteonecrosis of the femoral head","volume":"10","author":"Brown","year":"1992","journal-title":"J. Orthop. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1196\/annals.1402.069","article-title":"Perfusion Abnormalities in Subchondral Bone Associated with Marrow Edema, Osteoarthritis, and Avascular Necrosis","volume":"1117","author":"Aaron","year":"2007","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1302\/0301-620X.72B6.2246284","article-title":"Intra-osseous pressure and oxygen tension in avascular necrosis and osteoarthritis of the hip","volume":"72","author":"Kiaer","year":"1990","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"497","DOI":"10.22462\/11.12.2017.1","article-title":"Review on hyperbaric oxygen treatment in femoral head necrosis","volume":"44","author":"Camporesi","year":"2017","journal-title":"Undersea Hyperb. Med."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Bosco, G., Rizzato, A., Vezzani, G., Zanon, V., and Camporesi, E. (2018). Therapeutic Mechanisms of Action for Hyperbaric Oxygen on Femoral Head Necrosis. Hyperbaric Oxygen Treatment in Research and Clinical Practice\u2014Mechanisms of Action in Focus, IntechOpen.","DOI":"10.5772\/intechopen.75026"},{"key":"ref_28","first-page":"1085","article-title":"Uncemented total hip arthroplasty in patients less than 45 years with avascular necrosis","volume":"17","author":"Solacoff","year":"1993","journal-title":"Orthop. Trans."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"4434","DOI":"10.3892\/mmr.2015.4000","article-title":"Genetic variation in the coagulation factor V gene and risk of femoral head osteonecrosis","volume":"12","author":"Kim","year":"2015","journal-title":"Mol. Med. Rep."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"459","DOI":"10.2106\/00004623-199503000-00018","article-title":"Non-traumatic avascular necrosis of the femoral head","volume":"77","author":"Mont","year":"1995","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"18","DOI":"10.7812\/TPP\/18-100","article-title":"Osteonecrosis of the Hip: A Primer","volume":"23","author":"Lespasio","year":"2019","journal-title":"Perm. J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/j.bone.2014.10.025","article-title":"Twelve months of voluntary heavy alcohol consumption in male rhesus macaques suppresses intracortical bone remodeling","volume":"71","author":"Gaddini","year":"2015","journal-title":"Bone"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2494","DOI":"10.1111\/acer.14202","article-title":"Voluntary Chronic Heavy Alcohol Consumption in Male Rhesus Macaques Suppresses Cancellous Bone Formation and Increases Bone Marrow Adiposity","volume":"43","author":"Grant","year":"2019","journal-title":"Alcohol Clin. Exp. Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1056\/NEJMcp1012926","article-title":"Glucocorticoid-Induced Bone Disease","volume":"365","author":"Weinstein","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_35","first-page":"148","article-title":"Alcohol-Induced Adipogenesis in a Cloned Bone-Marrow Stem Cell","volume":"88","author":"Cui","year":"2006","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_36","first-page":"1046","article-title":"Pathomorphological changes of bone marrow adipocytes in process of steroid-associated osteonecrosis","volume":"6","author":"Sheng","year":"2013","journal-title":"Int. J. Clin. Exp. Pathol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1097\/01.blo.0000063602.67412.83","article-title":"Alcohol-Induced Adipogenesis in Bone and Marrow: A Possible Mechanism for Osteonecrosis","volume":"410","author":"Wang","year":"2003","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1016\/j.arth.2015.08.017","article-title":"Decreased Osteogenic Activity of Mesenchymal Stem Cells in Patients With Corticosteroid-Induced Osteonecrosis of the Femoral Head","volume":"31","author":"Houdek","year":"2016","journal-title":"J. Arthroplast."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1813","DOI":"10.12659\/MSM.909655","article-title":"MicroRNA Expression Profiling of Bone Marrow Mesenchymal Stem Cells in Steroid-Induced Osteonecrosis of the Femoral Head Associated with Osteogenesis","volume":"24","author":"Wang","year":"2018","journal-title":"Med. Sci. Monit."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1515\/hsz-2017-0241","article-title":"Changes of the peripheral blood mononuclear cells membrane fluidity from type 1 Gaucher disease patients: An electron paramagnetic resonance study","volume":"399","year":"2018","journal-title":"Biol. Chem."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.bone.2017.11.005","article-title":"Non traumatic osteonecrosis of the femoral head is associated with low bone mass","volume":"107","author":"Gangji","year":"2018","journal-title":"Bone"},{"key":"ref_42","first-page":"31","article-title":"Atraumatic Femoral Head Necrosis in Adults","volume":"113","author":"Arbab","year":"2016","journal-title":"Dtsch. Aerzteblatt Online"},{"key":"ref_43","first-page":"186","article-title":"Current management options for osteonecrosis of the femoral head: Part 1, diagnosis and nonoperative management","volume":"40","author":"Amanatullah","year":"2011","journal-title":"Am. J. Orthop."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Microsurgery Department of the Orthopedics Branch of the Chinese Medical Doctor Association, Group from the Osteonecrosis and Bone Defect Branch of the Chinese Association of Reparative and Reconstructive Surgery, and Microsurgery and Reconstructive Surgery Group of the Orthopedics Branch of the Chinese Medical Association (2017). Chinese Guideline for the Diagnosis and Treatment of Osteonecrosis of the Femoral Head in Adults. Orthop. Surg., 9, 3\u201312.","DOI":"10.1111\/os.12302"},{"key":"ref_45","first-page":"100","article-title":"Guidelines for clinical diagnosis and treatment of osteonecrosis of the femoral head in adults (2019 version)","volume":"21","author":"Zhao","year":"2020","journal-title":"J. Orthop. Transl."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1148\/radiology.212.2.r99au03527","article-title":"Idiopathic bone marrow edema lesions of the femoral head: Predictive value of MR imaging findings","volume":"212","author":"Malghem","year":"1999","journal-title":"Radiology"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1240","DOI":"10.1007\/s11999.0000000000000245","article-title":"Which Classification System Is Most Useful for Classifying Osteonecrosis of the Femoral Head?","volume":"476","author":"Takashima","year":"2018","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1007\/s00264-018-4018-4","article-title":"Classification systems of hip osteonecrosis: An updated review","volume":"43","author":"Sultan","year":"2019","journal-title":"Int. Orthop."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.ocl.2004.02.005","article-title":"Classification systems for osteonecrosis: An overview","volume":"35","author":"Steinberg","year":"2004","journal-title":"Orthop. Clin. N. Am."},{"key":"ref_50","first-page":"27","article-title":"Determining Lesion Size in Osteonecrosis of the Femoral Head","volume":"88","author":"Steinberg","year":"2006","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/j.arth.2019.05.039","article-title":"A Precise and Reliable Method of Determining Lesion Size in Osteonecrosis of the Femoral Head Using Volumes","volume":"35","author":"Hindoyan","year":"2020","journal-title":"J. Arthroplast."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1148\/radiology.161.3.3786725","article-title":"Avascular necrosis of the femoral head: Morphologic assessment by MR imaging, with CT correlation","volume":"161","author":"Mitchell","year":"1986","journal-title":"Radiology"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1148\/radiology.162.3.3809484","article-title":"Femoral head avascular necrosis: Correlation of MR imaging, radiographic staging, radionuclide imaging, and clinical findings","volume":"162","author":"Mitchell","year":"1987","journal-title":"Radiology"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1007\/s007760200108","article-title":"The 2001 revised criteria for diagnosis, classification, and staging of idiopathic osteonecrosis of the femoral head","volume":"7","author":"Sugano","year":"2002","journal-title":"J. Orthop. Sci."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/S0736-0266(01)00063-8","article-title":"Significance of lesion size and location in the prediction of collapse of osteonecrosis of the femoral head: A new three-dimensional quantification using magnetic resonance imaging","volume":"20","author":"Nishii","year":"2002","journal-title":"J. Orthop. Res."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"2589","DOI":"10.2106\/00004623-200412000-00001","article-title":"Fate of very small asymptomatic stage-I osteonecrotic lesions of the Hip","volume":"86","author":"Hernigou","year":"2004","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_57","first-page":"62","article-title":"Predicting the collapse of the femoral head due to osteonecrosis: From basic methods to application prospects","volume":"11","author":"Chen","year":"2017","journal-title":"J. Orthop. Transl."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1302\/0301-620X.75B2.8444940","article-title":"Avascular necrosis of the femoral head. Natural history and magnetic resonance imaging","volume":"75","author":"Takatori","year":"1993","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_59","first-page":"283","article-title":"Avascular necrosis of the femoral head: Inter- and intraobserver variations of Ficat and ARCO classifications","volume":"32","author":"Kirchhoff","year":"2007","journal-title":"Int. Orthop."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1055\/s-2001-15050","article-title":"Reproduzierbarkeit radiologischer Klassifikationskriterien der Femurkopfnekrose","volume":"139","author":"Riederle","year":"2001","journal-title":"Z. Orthop\u00e4die Ihre Grenzgeb."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1007\/s12178-015-9279-6","article-title":"Imaging evaluation of patients with osteonecrosis of the femoral head","volume":"8","author":"Pierce","year":"2015","journal-title":"Curr. Rev. Musculoskelet. Med."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13018-018-0836-8","article-title":"Accuracy of MRI diagnosis of early osteonecrosis of the femoral head: A meta-analysis and systematic review","volume":"13","author":"Zhang","year":"2018","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.ejrad.2007.03.029","article-title":"The role of MR imaging in staging femoral head osteonecrosis","volume":"63","author":"Zibis","year":"2007","journal-title":"Eur. J. Radiol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"363","DOI":"10.2214\/ajr.180.2.1800363","article-title":"Subchondral Fractures in Osteonecrosis of the Femoral Head: Comparison of Radiography, CT, and MR Imaging","volume":"180","author":"Stevens","year":"2003","journal-title":"Am. J. Roentgenol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1007\/s00256-009-0659-0","article-title":"Diagnostic performance of MR imaging in the assessment of subchondral fractures in avascular necrosis of the femoral head","volume":"38","author":"Yeh","year":"2009","journal-title":"Skelet. Radiol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1093\/rheumatology\/kes241","article-title":"There are many potential medical therapies for atraumatic osteonecrosis","volume":"52","author":"Fessel","year":"2012","journal-title":"Rheumatology"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1097\/00003086-200105000-00022","article-title":"Statin Therapy Decreases the Risk of Osteonecrosis in Patients Receiving Steroids","volume":"386","author":"Pritchett","year":"2001","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1177\/1535370213519215","article-title":"Pravastatin prevents steroid-induced osteonecrosis in rats by suppressing PPAR\u03b3 expression and activating Wnt signaling pathway","volume":"239","author":"Jiang","year":"2014","journal-title":"Exp. Biol. Med."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.ocl.2009.01.004","article-title":"Does Statin Usage Reduce the Risk of Corticosteroid-Related Osteonecrosis in Renal Transplant Population?","volume":"40","author":"Ajmal","year":"2009","journal-title":"Orthop. Clin. N. Am."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2015\/138382","article-title":"Long Term Anticoagulation (4\u201316 Years) Stops Progression of Idiopathic Hip Osteonecrosis Associated with Familial Thrombophilia","volume":"2015","author":"Glueck","year":"2015","journal-title":"Adv. Orthop."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"e6646","DOI":"10.1097\/MD.0000000000006646","article-title":"The use of anticoagulants for prevention and treatment of osteonecrosis of the femoral head","volume":"96","author":"Guo","year":"2017","journal-title":"Medicine"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1503\/cjs.016814","article-title":"Treatment with acetylsalicylic acid prevents short to mid-term radiographic progression of nontraumatic osteonecrosis of the femoral head: A pilot study","volume":"58","author":"Albers","year":"2015","journal-title":"Can. J. Surg."},{"key":"ref_73","first-page":"6150","article-title":"Long-term clinical results after iloprost treatment for bone marrow edema and avascular necrosis","volume":"8","author":"Becker","year":"2016","journal-title":"Orthop. Rev."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1128","DOI":"10.1016\/j.arth.2010.11.010","article-title":"Ten-Year Follow-Up of Avascular Necrosis of Femoral Head Treated with Alendronate for 3 Years","volume":"26","author":"Agarwala","year":"2011","journal-title":"J. Arthroplast."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1572","DOI":"10.1002\/art.33498","article-title":"Alendronate in the prevention of collapse of the femoral head in nontraumatic osteonecrosis: A two-year multicenter, prospective, randomized, double-blind, placebo-controlled study","volume":"64","author":"Chen","year":"2012","journal-title":"Arthritis Rheum."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.2106\/JBJS.N.01157","article-title":"Does Zoledronate Prevent Femoral Head Collapse from Osteonecrosis?","volume":"97","author":"Lee","year":"2015","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1007\/s00198-015-3317-5","article-title":"The use of bisphosphonate in the treatment of osteonecrosis of the femoral head: A meta-analysis of randomized control trials","volume":"27","author":"Yuan","year":"2016","journal-title":"Osteoporos. Int."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"1450","DOI":"10.1038\/s41598-018-19884-z","article-title":"Efficacy of bisphosphonates in the treatment of femoral head osteonecrosis: A PRISMA-compliant meta-analysis of animal studies and clinical trials","volume":"8","author":"Li","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_79","first-page":"1","article-title":"Bisphosphonate Combination Therapy in the Management of Postchemotherapy Avascular Necrosis of the Femoral Head in Adolescents and Young Adults: A Retrospective Study from India","volume":"4","author":"Agarwala","year":"2018","journal-title":"J. Glob. Oncol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13018-018-0861-7","article-title":"Meta-analysis of the potential role of extracorporeal shockwave therapy in osteonecrosis of the femoral head","volume":"13","author":"Hao","year":"2018","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1007\/s00132-018-03682-6","article-title":"Clinical efficacy of individual extracorporeal shockwave treatment","volume":"48","author":"Ding","year":"2019","journal-title":"Orthop\u00e4de"},{"key":"ref_82","first-page":"56","article-title":"Biophysical Stimulation with Pulsed Electromagnetic Fields in Osteonecrosis of the Femoral Head","volume":"88","author":"Massari","year":"2006","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_83","doi-asserted-by":"crossref","unstructured":"Al-Jabri, T., Tan, J.Y.Q., Tong, G.Y., Shenoy, R., Kayani, B., Parratt, T., and Khan, T. (2017). The role of electrical stimulation in the management of avascular necrosis of the femoral head in adults: A systematic review. BMC Musculoskelet. Disord., 18.","DOI":"10.1186\/s12891-017-1663-5"},{"key":"ref_84","doi-asserted-by":"crossref","unstructured":"Giacon, T.A., Giancola, F., Paganini, M., Tiengo, C., Camporesi, E.M., and Bosco, G. (2021). Hyperbaric Oxygen Therapy and A-PRF Pre-Treated Implants in Severe Periodontitis: A Case Report. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18020413"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"131S","DOI":"10.1097\/PRS.0b013e3181fbe2bf","article-title":"Hyperbaric Oxygen: Its Mechanisms and Efficacy","volume":"127","author":"Thom","year":"2011","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_86","first-page":"247","article-title":"Mechanisms of action of hyperbaric oxygen therapy","volume":"41","author":"Camporesi","year":"2014","journal-title":"Undersea Hyperb. Med."},{"key":"ref_87","doi-asserted-by":"crossref","unstructured":"Gardin, C., Bosco, G., Ferroni, L., Quartesan, S., Rizzato, A., Tatullo, M., and Zavan, B. (2020). Hyperbaric Oxygen Therapy Improves the Osteogenic and Vasculogenic Properties of Mesenchymal Stem Cells in the Presence of Inflammation In Vitro. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21041452"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1016\/j.jdent.2014.10.006","article-title":"Hyperbaric oxygen therapy accelerates osteoblast differentiation and promotes bone formation","volume":"43","author":"Smerdon","year":"2015","journal-title":"J. Dent."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1016\/j.artd.2018.02.010","article-title":"Femoral condylar necrosis: Treatment with hyperbaric oxygen therapy","volume":"4","author":"Bosco","year":"2018","journal-title":"Arthroplast. Today"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"1501","DOI":"10.1080\/14756366.2018.1485149","article-title":"Hyperbaric oxygen therapy ameliorates osteonecrosis in patients by modulating inflammation and oxidative stress","volume":"33","author":"Bosco","year":"2018","journal-title":"J. Enzym. Inhib. Med. Chem."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1007\/s00132-016-3360-8","article-title":"Clinical effect of hyperbaric oxygen therapy in the treatment of femoral head necrosis","volume":"46","author":"Li","year":"2016","journal-title":"Orthop\u00e4de"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1302\/0301-620X.85B3.13237","article-title":"Hyperbaric oxygen therapy as a treatment for stage-I avascular necrosis of the femoral head","volume":"85","author":"Reis","year":"2003","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1007\/s00402-009-0918-5","article-title":"Cocktail therapy for femoral head necrosis of the hip","volume":"130","author":"Hsu","year":"2009","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.arth.2010.05.005","article-title":"Hyperbaric Oxygen Therapy in Femoral Head Necrosis","volume":"25","author":"Camporesi","year":"2010","journal-title":"J. Arthroplast."},{"key":"ref_95","first-page":"122","article-title":"Tenth European Consensus Conference on Hyperbaric Medicine: Preliminary report","volume":"46","author":"Mathieu","year":"2016","journal-title":"Diving Hyperb. Med. J."},{"key":"ref_96","first-page":"105","article-title":"Hyperbaric oxygen therapy improved both pain scores and range of motion in patients with early idiopathic femoral head necrosis (Ficat stage II)","volume":"41","author":"Bennett","year":"2011","journal-title":"Diving Hyperb. Med. J."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1016\/S0140-6736(18)31665-9","article-title":"How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up","volume":"393","author":"Evans","year":"2019","journal-title":"Lancet"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1086\/652156","article-title":"Should National Standards for Reporting Surgical Site Infections Distinguish between Primary and Revision Orthopedic Surgeries?","volume":"31","author":"Leekha","year":"2010","journal-title":"Infect. Control. Hosp. Epidemiol."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"S101","DOI":"10.1016\/j.arth.2020.01.047","article-title":"Total Hip Arthroplasty for Femoral Neck Fracture: The Economic Implications of Orthopedic Subspecialty Training","volume":"35","author":"Padilla","year":"2020","journal-title":"J. Arthroplast."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1186\/s13018-019-1531-0","article-title":"Effect of hospital volume on outcomes of total hip arthroplasty: A systematic review and meta-analysis","volume":"14","author":"Mufarrih","year":"2019","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/S0140-6736(10)61085-9","article-title":"Decompression illness","volume":"377","author":"Vann","year":"2011","journal-title":"Lancet"},{"key":"ref_102","first-page":"801","article-title":"Effects of hyperbaric oxygen exposure on mobilization of endothelial progenitor cells in healthy volunteers","volume":"33","author":"Vezzani","year":"2017","journal-title":"Acta Med. Mediterr."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1111\/j.1440-1681.2007.04548.x","article-title":"Effects of hyperbaric oxygen on glucose, lactate, glycerol and anti-oxidant enzymes in the skeletal muscle of rats during ischaemia and reperfusion","volume":"34","author":"Bosco","year":"2007","journal-title":"Clin. Exp. Pharmacol. Physiol."},{"key":"ref_104","first-page":"72","article-title":"Beneficial effect of hyperbaric oxygenation in avascular necrosis of the femoral head","volume":"177","author":"Vezzani","year":"2018","journal-title":"Gazz. Medica Ital. Arch Sci. Med."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"e200","DOI":"10.3928\/01477447-20150305-57","article-title":"Hyperbaric Oxygen for Stage I and II Femoral Head Osteonecrosis","volume":"38","author":"Koren","year":"2015","journal-title":"Orthopedics"},{"key":"ref_106","unstructured":"Vezzani, G., Zanon, V., Manelli, D., Camporesi, E.M., and Bosco, G. (2016, January 15\u201316). Report on HyperBaric Oxygen (HBO2) in femoral head necrosis. Proceedings of the 10th ECHM Consensus Conference of Hyperbaric Medicine, Lille, France."},{"key":"ref_107","first-page":"189","article-title":"Hyperbaric oxygen therapy in the treatment of osteonecrosis of the femoral head: A review of the current literature","volume":"43","author":"Uzun","year":"2016","journal-title":"Undersea Hyperb. Med."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"1839","DOI":"10.1002\/jor.22443","article-title":"Hyperbaric oxygen therapy suppresses osteoclast formation and bone resorption","volume":"31","author":"Smerdon","year":"2013","journal-title":"J. Orthop. Res."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1016\/j.cytogfr.2004.06.004","article-title":"The molecular triad OPG\/RANK\/RANKL: Involvement in the orchestration of pathophysiological bone remodeling","volume":"15","author":"Theoleyre","year":"2004","journal-title":"Cytokine Growth Factor Rev."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.cytogfr.2003.10.005","article-title":"IL-6, RANKL, TNF-alpha\/IL-1: Interrelations in bone resorption pathophysiology","volume":"15","author":"Steeve","year":"2004","journal-title":"Cytokine Growth Factor Rev."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"3212","DOI":"10.3892\/mmr.2015.3152","article-title":"Receptor activator of nuclear factor-\u03baB ligand (RANKL)\/RANK\/osteoprotegerin system in bone and other tissues (Review)","volume":"11","author":"Liu","year":"2014","journal-title":"Mol. Med. Rep."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1080\/14756366.2017.1302440","article-title":"Hyperbaric oxygen therapy modulates serum OPG\/RANKL in femoral head necrosis patients","volume":"32","author":"Vezzani","year":"2017","journal-title":"J. Enzym. Inhib. Med. Chem."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"264","DOI":"10.3109\/17453674.2014.964621","article-title":"Osteoclastic resorptive capacity is suppressed in patients receiving hyperbaric oxygen therapy","volume":"86","author":"Smerdon","year":"2015","journal-title":"Acta Orthop."},{"key":"ref_114","first-page":"96","article-title":"Hyperbaric O 2 reduces intestinal ischemia-reperfusion-induced TNF-\u03b1 production and lung neutrophil sequestration","volume":"85","author":"Yang","year":"2001","journal-title":"Graefe\u2019s Arch. Clin. Exp. Ophthalmol."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1016\/j.jfma.2014.03.012","article-title":"Repetitive hyperbaric oxygen therapy provides better effects on brain inflammation and oxidative damage in rats with focal cerebral ischemia","volume":"113","author":"Chen","year":"2014","journal-title":"J. Formos. Med. Assoc."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"1672","DOI":"10.1097\/MAO.0b013e31826bf3f6","article-title":"Effects of Hyperbaric Oxygen and Dexamethasone on Proinflammatory Cytokines of Rat Cochlea in Noise-Induced Hearing Loss","volume":"33","author":"Arslan","year":"2012","journal-title":"Otol. Neurotol."},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"1722","DOI":"10.1002\/jor.20164","article-title":"Endothelial nitric oxide synthase gene polymorphisms in patients with nontraumatic femoral head osteonecrosis","volume":"24","author":"Koo","year":"2006","journal-title":"J. Orthop. Res."},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"2460","DOI":"10.2106\/00004623-200711000-00018","article-title":"Association Between the T-786C eNOS Polymorphism and Idiopathic Osteonecrosis of the Head of the Femur","volume":"89","author":"Glueck","year":"2007","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.1007\/s00264-013-1892-7","article-title":"Endothelial nitric oxide synthase gene intron 4 polymorphism in non-traumatic osteonecrosis of the femoral head","volume":"37","author":"Gagala","year":"2013","journal-title":"Int. Orthop."},{"key":"ref_120","doi-asserted-by":"crossref","unstructured":"Zheng, L., Wang, W., Ni, J., Li, Z., and Xiao, T. (2014). The Association of eNOS Gene Polymorphism with Avascular Necrosis of Femoral Head. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0087583"},{"key":"ref_121","first-page":"18849","article-title":"Correlation between polymorphism of endothelial nitric oxide synthase and avascular necrosis of femoral head","volume":"8","author":"Zhang","year":"2015","journal-title":"Int. J. Clin. Exp. Med."},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"13688","DOI":"10.4238\/2015.October.28.31","article-title":"VEGF, eNOS, and ABCB1 genetic polymorphisms may increase the risk of osteonecrosis of the femoral head","volume":"14","author":"Zhou","year":"2015","journal-title":"Genet. Mol. Res."},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"352","DOI":"10.17305\/bjbms.2018.3259","article-title":"Epidermal growth factor (EGF) promotes bone healing in surgically induced osteonecrosis of the femoral head (ONFH)","volume":"18","author":"Basal","year":"2018","journal-title":"Bosn. J. Basic Med. Sci."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/6\/2888\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:34:28Z","timestamp":1760160868000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/6\/2888"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,12]]},"references-count":123,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,3]]}},"alternative-id":["ijerph18062888"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18062888","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,12]]}}}