Fighting Chronic Bone Infections (Osteomyelitis): How HBOT Can Help

Chronic Refractory Osteomyelitis (CRO) is a challenging bone infection that can be difficult to treat and devastating for patients. When traditional therapies aren't enough, Hyperbaric Oxygen Therapy (HBOT) offers a valuable adjunctive option to support healing and fight infection.

Successful management requires more than a single intervention—it demands a coordinated, multidisciplinary approach. HBOT plays a critical role in these efforts, helping to enhance outcomes in complex, non-healing cases.

As a prototypical "problem wound," CRO demands meticulous care planning, close coordination among specialties, and a strong commitment to patient-centered care.

What is CRO?

CRO is both an ischemic and infectious disease. The dense fibrous tissue produced by the body to isolate the infected area results in tissue pO₂ levels below the 30–40 mmHg required for collagen synthesis by fibroblasts, bone synthesis by osteoblasts, and a normal leukocyte response. Once tissue pO₂ falls below 30 mmHg, leukocytes are unable to phagocytize bacteria, and ischemia impedes the delivery of high-dose antibiotics into the infected area.¹ ³

Adjunctive Use of HBOT in the Treatment of CRO

CRO is characterized by recurrent flare-ups resulting in pain, drainage, or other signs of acute inflammation. Hyperbaric oxygen therapy is not a substitute for surgery or appropriate antibiotics but has demonstrated adjunctive value in cases unresponsive to conventional treatment.

HBOT helps raise tissue pO₂ levels above 30 mmHg, enhancing osteogenesis and neovascularization to fill dead space with vascularized, structurally sound tissue. Improved vascularity facilitates the entry of leukocytes, antibodies, and antibiotics to the infected area. HBOT also stimulates osteoclastic activity, aiding in the removal of bony debris.¹ ² ³

While hyperbaric oxygen therapy (HBOT) does not have a direct bactericidal effect against most organisms (except anaerobes), it significantly potentiates the immune response and supports healing. HBOT has demonstrated clinical effectiveness even in cases where antibiotics alone have proven insufficient. Researchers have shown that leukocyte-mediated killing of infectious organisms improves substantially at tissue oxygen tensions above 30 mmHg, peaking around 150 mmHg—levels achievable only through hyperbaric oxygen therapy.¹ ² ³

Which patients will benefit from HBOT?

Patients suitable for HBOT include those with CRO who meet one or more of the following criteria:

• Have failed to respond to appropriate, organism-specific antibiotic therapy

• Have failed to respond to at least one surgical procedure intended to eradicate infection

• Have experienced recurrence after initial treatment efforts

  
  

Clinical evidence and Medicare coverage guidelines support the adjunctive use of HBOT in managing these cases. When used alongside standard therapies, HBOT has been associated with remission rates approaching 85% in refractory osteomyelitis patients.²

References:

1. Esterhai J, Pisarello J, Brighton C, et al. Adjunctive hyperbaric oxygen therapy in the treatment of chronic refractory osteomyelitis. The Journal of Trauma. 1987;27(7):763–768.

2. Goldman RJ. Hyperbaric oxygen therapy for wound healing and limb salvage: a systematic review. PM&R: The Journal of Injury, Function, and Rehabilitation. 2009;1(5):471–479.

3. Lazzarini L, Mader JT, Calhoun JH. Osteomyelitis in long bones. Journal of Bone and Joint Surgery. 2004;86-A(10):2305–2318.

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