What Is Bone Marrow Oedema?
Bone marrow oedema is a pathological condition in which fluid accumulates within the cancellous bone, increasing intraosseous pressure and consequently causing significant pain. It is not a disease in itself, but rather an anatomical response indicating that the bone tissue is under stress or has been affected by injury or ischaemia.
It commonly occurs in physically active individuals and athletes, but may also affect older adults with osteoporosis or develop following an injury. The femoral head, knee and ankle are among the most frequently affected areas.
The main symptoms include diffuse pain in the affected area, worsening pain during weight-bearing, stiffness and, in many cases, difficulty walking. Diagnosis is primarily made by magnetic resonance imaging (MRI), which typically reveals areas of high signal intensity on T2-weighted sequences.
Characteristics of Bone Marrow Oedema
Bone marrow oedema may persist for several weeks or even months despite conservative treatment. The reduced blood supply that often accompanies the condition creates an environment of local hypoxia, meaning insufficient oxygenation within the bone tissue, which can delay the natural healing process.
Different forms are recognised according to their underlying cause, including overload-related oedema, also known as a stress reaction, ischaemic oedema, post-traumatic oedema and oedema associated with other conditions, such as osteonecrosis.
In all cases, failure to address the condition promptly may lead to more serious tissue damage, including collapse of the articular surface.
The chronic form of the condition can be particularly painful and may require long-term monitoring and a targeted treatment approach.
Scientific Basis
The role of local hypoxia in the pathophysiology of bone marrow oedema has been studied extensively. Research suggests that restoring oxygenation to the affected areas is an important factor in reducing symptoms and supporting the recovery of bone integrity.
Clinical reports and case studies evaluating hyperbaric oxygen therapy in patients with bone marrow oedema of the femoral head and knee have recorded significant improvements in both pain scores and MRI findings following completion of the treatment course.
The neovascularisation induced by hyperbaric oxygen therapy appears to play a central role in this improvement.
Hyperbaric Oxygen Therapy for Bone Marrow Oedema
Hyperbaric oxygen therapy does not replace the conservative management of bone marrow oedema. It may, however, provide an important adjunctive option for patients who do not respond adequately to standard treatment or who wish to support a faster recovery.
Its mechanism of action is based on increasing the partial pressure of oxygen within the tissues. Under hyperbaric conditions, typically at 2–2.5 ATA, substantially greater quantities of oxygen dissolve in the blood and reach areas with impaired capillary circulation that may not receive adequate oxygen through normal haemodynamic mechanisms.
Η αυξημένη οξυγόνωση ενεργοποιεί τους οστεοβλάστες, τα κύτταρα που είναι υπεύθυνα για τη σύνθεση νέου οστικού ιστού και παράλληλα μειώνει τα φλεγμονώδη κυτοκίνη που συντηρούν το οίδημα. Επιπλέον, η υπερβαρική οξυγονοθεραπεία τονώνει την παραγωγή αγγειακού ενδοθηλιακού αυξητικού παράγοντα (VEGF), συμβάλλοντας στη δημιουργία νέων αιμοφόρων αγγείων στην πάσχουσα περιοχή.
The increased oxygen supply activates osteoblasts, the cells responsible for producing new bone tissue, while also reducing the inflammatory cytokines that contribute to the persistence of oedema. Hyperbaric oxygen therapy also stimulates the production of vascular endothelial growth factor (VEGF), promoting the formation of new blood vessels in the affected area.
A typical treatment course for bone marrow oedema consists of 20 to 40 sessions, each lasting approximately 60 to 90 minutes. Treatment is always planned in consultation with the orthopaedic surgeon or treating physician.
Follow-up MRI after completion of the treatment course allows the clinical team to assess the patient’s response and determine the next stage of management.