The effects of systemic ozone application and hyperbaric oxygen therapy on avascular necrosis of the femoral head: An experimental study in the vascular deprivation of the rat femoral head model
Onur Yılmaz1
, Hüseyin Yener Erken2, Meltem İçkin Gülen3, Aysel Güven Bağla3, Yasemen Adalı4, Tolgahan Kuru2
1Department of Orthopedics and Traumatology, Çanakkale Mehmet Akif Ersoy State Hospital, Çanakkale, Türkiye
2Department of Orthopedics and Traumatology, Çanakkale Onsekiz Mart University, Çanakkale, Türkiye
3Department of Histology and Embryology, Çanakkale Onsekiz Mart University, Çanakkale, Türkiye
4Department of Pathology, İzmir Democracy University, İzmir, Türkiye
Keywords: Avascular necrosis, femoral head, hyperbaric oxygen, osteonecrosis, ozone.
Abstract
Objectives: This study aims to assess the effects of systemic medical ozone (O3) application and to compare its effects with hyperbaric oxygen (HBO) therapy for preventing avascular necrosis of the femoral head in a rat model.
Materials and methods: A total of 50 male Wistar albino rats were divided into six groups including five rats in each control and sham-operated control group and 10 rats in the remaining four groups: (i) control group, (ii) sham-operated control group, (iii) avascular necrosis group, (iv) intraperitoneal ozone given avascular necrosis group, (v) HBO therapy given avascular necrosis group, and (vi) intraperitoneal ozone and HBO given avascular necrosis group. We surgically induced osteonecrosis by cutting the ligamentum teres and placing a tight ligature around the femoral neck. At Week 11, we harvested femoral heads bilaterally from each animal and performed a macroscopic, histological evaluation and histomorphometric, immunohistochemical analysis.
Results: The intertrabecular mesenchymal cell ratio was substantially higher in the O3 group than that of all other groups in the histological evaluation (p<0.05). Group O3 had also significantly more CD31-positive stained new vasculature than other groups, with the exception of the HBO therapy group, according to the immunohistochemical analysis (p<0.05).
Conclusion: The results of this experimental study suggest that the application of medical ozone alone may have a positive effect on new vessel formation and the repair process and may be more beneficial than HBO therapy and HBO+O3 therapy in the vascular deprivation of the rat femoral head model.
Citation: Yılmaz O, Erken HY, İçkin Gülen M, Güven Bağla A, Adalı Y, Kuru T. The effects of systemic ozone application and hyperbaric oxygen therapy on avascular necrosis of the femoral head: An experimental study in the vascular deprivation of the rat femoral head model. Jt Dis Relat Surg 2025;36(2):293-303. doi: 10.52312/jdrs.2025.1959.
Idea/concept, literature review, writing the article: H.Y.E., O.Y.; Design: O.Y.; Control/ supervision: H.Y.E., T.K.; Data collection and/or processing: M.İ.G., A.G.B., Y.A.; Analysis and/or interpretation, critical review: O.Y., T.K.; References and fundings, materials: M.İ.G., A.G.B., Y.A.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
This work was supported by Çanakkale Onsekiz Mart University The Scientific Research Coordination Unit. Project number: THD-2020-3189.
The data that support the findings of this study are available from the corresponding author upon reasonable request.