Ultrasound-Guided Intra-Articular Ozone Injection as a Therapeutic Option for Hip Osteonecrosis

Abstract

Osteonecrosis, also known as avascular necrosis, is a disease caused by decreased blood flow to the bones of joints. Trauma, steroid use, alcoholism and hematological diseases are some of the important causes of osteonecrosis. 1 When osteonecrosis is diagnosed early, operative and non-operative treatments have been described with variable success rates. 2 Non-operative treatment options include a variety of medications (nonsteroidal anti-inflammatory drugs, bisphosphonates, anticoagulants, cholesterollowering drugs, vasodilators, etc.), physiotherapy methods (exercises, electrical stimulation, extracorporeal shock wave therapy, pulsed electromagnetic therapy) and hyperbaric oxygen therapy. 3 These treatment options have recently been recommended for the prevention of osteonecrosis progression. 1 Rege-nerative therapies including stem cells, platelet-rich plasma and bioactive molecules also achieve good clinical results for the treatment of osteonecrosis. 4 In this case, a patient with bilateral hip pain due to osteonecrosis caused by long-term steroid usage for Hodgkin's lymphoma was treated with intra-articular ozone. The results show the short-term effect of ozone. CASE REPORT A 45-year old male presented with complaints of bilateral hip pain and walking difficulties for the last year, and nocturnal hip pain. The initial pain assessment was measured as VAS 7 (Visual Analogue Scale). The medical history revealed a 5-year history of Hodgkin's lymphoma and 1 year previously, core