Osteomyelitis is a serious bone infection that can be difficult to treat, particularly when the infection becomes chronic or returns despite appropriate medical care. Treatment commonly involves culture-directed antibiotics, wound management and, when necessary, surgical removal of infected or dead bone. However, some patients may continue to experience infection because damaged bone and surrounding tissues have a poor oxygen supply.
This is where Hyperbaric Oxygen Therapy (HBOT) may have an important supportive role. HBOT involves breathing medical-grade oxygen inside a pressurized chamber, allowing oxygen levels in the blood and tissues to rise significantly. Increased tissue oxygenation may support the body’s immune response, promote new blood vessel formation and assist the healing of damaged bone and soft tissue.
HBOT is recognized as an adjunctive option for refractory osteomyelitis, particularly when the infection persists or returns despite appropriate conventional treatment. It is generally used alongside, rather than instead of, antibiotics and indicated surgical treatment.
In this article, we explore the role of HBOT in osteomyelitis, how it may support bone healing, when it may be considered and what patients should know before undergoing treatment.
What is Osteomyelitis?
Osteomyelitis is an infection-related inflammation or swelling of the bone tissues. Bone infections can affect both children and adults and can happen for a variety of causes. A systemic bacterial infection that spreads to the bones, often known as sepsis or bacteria, can result in osteomyelitis. This form typically affects a child’s long bones, such as the femur (thighbone) or humerus, and is most prevalent in infants and young children (upper arm bone). Adult cases of osteomyelitis frequently involve the vertebral bones along the spinal column. Staphylococcus aureus is typically the cause of the blood infection, while other bacteria or fungi may also be to blame. Osteomyelitis is more prone to occur in those with compromised immune systems. People who have sickle cell disease, HIV, or who are taking immunosuppression drugs like chemotherapy or steroids fall under this category. Depending on the cause of the infection, osteomyelitis may start suddenly, slowly, and mildly, or it may develop into a chronic condition. Out of every 10,000 people, 2 to 5 will get osteomyelitis. One of the earliest known disorders and its origins have been established to be more than 250 million years old.
Types
The following are osteomyelitis sub-types:
Acute: The onset of this infection is abrupt. You might have a fever for a few days before experiencing pain in the infected area.
Chronic: Chronic osteomyelitis is an infection of the bones that is resistant to medical care. It results in persistent leakage and bone pain. Occasionally, persistent osteomyelitis goes undiagnosed.
Vertebral: The spine is affected by this type. It results in persistent back pain that worsens as you move. It seldom results in a fever. Spinal bone infections are more common in people who reside in nursing homes, abuse intravenous medications, or are receiving dialysis.
Causes
Osteomyelitis develops when germs travel via your blood from adjacent sick tissue or an open lesion and land in bone, where they multiply. Osteomyelitis is frequently caused by infections, or Staphylococcus aureus bacteria. A bone infection can occasionally be brought on by a fungus or other microbe. Staphylococcus aureus is the etiological pathogen in 30% to 60% of human osteomyelitis cases, while staphylococci as a group are responsible for about 75% of cases. Osteomyelitis is an infectious disease that affects the bone and bone marrow. Osteomyelitis typically results from a traumatic or hematogenous cause. Children under the age of 16 are most frequently affected by the hematogenous spread of germs, which causes hematogenous osteomyelitis.
The following conditions increase your risk of developing osteomyelitis:
- A hip replacement is an artificial joint
- disorders including sickle cell anaemia or blood infections
- Diabetes, particularly a foot ulcer brought on by diabetes
- Bone implants made of metal, like screws
- Pressure wounds (bedsores)
- Recent bone surgery or bone fracture
- Traumatic wound or injury
- Inadequate immune system
Symptoms
The infected area may also be red, heated, swollen, and painful to the touch. As further indications of osteomyelitis include:
- Drainage (yellow pus)
- Irritability or sluggishness
- Painful and restricted movement
- Decrease in appetite
- A lower back aches
- Vomiting and nausea
- Chills
Diagnosis
Your doctor may recommend one or more of the following tests after evaluating your symptoms and conducting a physical examination:
- Complete blood counts (Cb Cs) in blood tests look for indicators of infection and inflammation. An examination of your blood culture checks for germs.
- Images of your bones, muscles, and tissues are produced by imaging tests like X-rays, MRI’s, CT scans, and ultrasounds.
- Bone scan: During an imaging scan, a bone scan employs a little amount of harmless, radioactive material to find infections or fractures.
- Biopsy: A needle biopsy is conducted by your healthcare professional to obtain samples of fluid, tissue, or bone that will be examined for indications of infection.
Treatment
Healing from a bone infection might take an exceptionally long time. If you begin therapy within three to five days after first seeing symptoms, the infection can go away more quickly.
Treatments include:
Antibiotics: Antibiotics eliminate microorganisms that cause infections. Antibiotics may be required for four to eight weeks, beginning with intravenous (IV) antibiotics administered in the hospital for one or two weeks. After that, you will take drugs orally for a few weeks. Antibiotics may be needed for months to treat chronic illnesses.
Antifungals: You may need to take oral antifungal drugs for months to treat fungal infections. Your healthcare professional will use a tiny needle to aspirate the pus and liquid from the abscess. Non-steroidal anti-inflammatory medications (NSA-IDs) are used to treat inflammation and pain. In some cases, surgery is required to treat bone infections. After surgery, antibiotics will be required. the following surgical options:
Bone surgery: The infected, dead tissue and bone are surgically removed (derided) by your healthcare practitioner. Bone abnormalities could develop because of this surgery.
Those who have vertebral osteomyelitis may require spine surgery. By doing this operation, you can prevent vertebrae from collapsing and harming your spinal cord, nerves, and other nervous system components.
Hyperbaric Oxygen as Effective Medicine for Osteomyelitis
By administering pure oxygen under high pressure, Hyperbaric Oxygen Treatment (HBOT) increases the amount of oxygen in the blood and tissues (hyperoxia) (about 2-3 atmospheres). One method of treatment involves being exposed to pure oxygen (O2) concentrations at high atmospheric pressures using hyperbaric oxygen therapy (HBOT). According to the Undersea and Hyperbaric Medical Society, this pressure may be greater than or equivalent to 1.4 atmospheres. For all current UH-MS-approved uses, patients may only inhale oxygen when restrained in a space with a minimum air pressure of 2 ATA. For hyperbaric medicine to work, there needs to be a pressure environment that is greater than the air pressure at sea level. Hyperbaric oxygen treatment (HBOT) has been shown to rejuvenate bone cells and encourage natural development. Collagen is needed to fill up the spaces between broken bones so they can heal, and HBOT promotes its production. Hyperbaric oxygen may also promote the growth of osteoblasts and osteoclasts, two cell types necessary for breaking down old, dead bone and forming new bone.
Conclusion on HBOT for Osteomyelitis
Osteomyelitis can be a challenging condition, especially when infection persists or returns despite antibiotics and appropriate surgical treatment. Managing the condition successfully often requires a combination of medical, surgical and supportive approaches.
Hyperbaric Oxygen Therapy can play a valuable adjunctive role in selected cases of refractory osteomyelitis. By increasing oxygen availability in poorly oxygenated tissues, HBOT may support immune function, tissue repair, blood vessel formation and bone healing. Current hyperbaric medicine guidance recognizes refractory osteomyelitis as an established indication for HBOT, while emphasizing its use alongside appropriate antibiotics and surgical management when required.
However, HBOT is not a standalone cure for every bone infection, and treatment should always be planned after a proper medical evaluation. The decision to undergo HBOT depends on factors such as the type and severity of osteomyelitis, previous treatment, infection response, tissue condition and the patient’s overall health.
If you or a loved one is dealing with persistent or recurrent osteomyelitis, consult a qualified healthcare professional or hyperbaric medicine specialist to determine whether HBOT may be an appropriate part of the overall treatment plan.
