L Prakash1*, Prasham Shah2, Aroop Mukharjee3 and Jignesh Patel4
1Orthopaedic Chief, Institute for Special Orthopaedics, Palakkad, Kerala, India
2Consultant Orthopaedic Surgeon, Wokhardt Hospital, Mumbai, India
3Consultant Orthopaedic Surgeon, Max Hospital, New Delhi, India
4Professor of Orthopaedics, Government Medical College, Surat, Gujrat, India
*Corresponding Author: L Prakash, Orthopaedic Chief, Institute for Special Orthopaedics, Palakkad, Kerala, India.
Received: March 18, 2025; Published: May 27, 2025
The current post COVID era is facing an epidemic of avascular Necrosis of femoral heads [1], largely in younger patients [2], and most patients of FICAT stage 2/3/4 are offered surgical intervention including total hip replacement. This paper is a prospective study of 36 patients with AVN stage 2/3 and 4, treated by the authors’ special regimen of Hydrozone gaseous arthrodesis, high ozone dose EBOO (extra corporal blood oxygen ozonisation) or MAHT (Major Auto Haemo Therapy) and a combination of low dose DMARD termed Mukharjee regimen in an attempt to preserve the hip joint and avoid total hip replacement.
Background: Idiopathic avascular necrosis (not related to trauma internal fixation or direct known causes) was 0.4% of the population in 2015 [3], which has now become 6% in 2023 [4,5], a 1500% increase, which is mostly attributed to one of the factors, covid infection, high dose steroids treatment for covid infection or covid vaccination4. This prospective study was designed on the premise that if oxygenation to the head could be improved by haematogenous route, decreased joint space could be expanded by gaseous arthrodiastesis, and synovial constrictive proliferative strangulating the vascular supply subdued by methotrexate in very low doses, the progress of AVN could be slowed down and the hip joint could be preserved. This is a prospective study on 36 patients followed up until 18 months.
Methods: 36 patients, 19 males and 17 females between the ages of 21 and 47, with avascular necrosis of their femoral heads, ranging from Ficat grade 2 to 4, were treated with intraarticular Hydrozone injections, Extra corporeal Blood Oxygen Ozonisation, or Major Autohaemotherapy with low dose methotrexate Mukharjee regimen for 18 months. Hydrozone arthrodiastesis and EBOO/ MAHT sessions were repeated every week for three weeks, and then once every four months for four times. The patients were evaluated pre and post treatment of 18 months using VAS scores, Harris Hip score and Oxford Hip score.
Results: The study was a prospective non randomised consecutive analysis of 36 patients, 19 males and 17 females between the ages of 21 and 47. Two patients left the treatment midway through and one patient died due to unrelated reasons. (Accident). Of the remaining 33 patients 29 patients had excellent and 4 patients had good results, with VAS scores coming down from 8-10 to 1-3. The Harris hip score pre therapy was in the range of 60 to 70 improved to 94 to 98. Oxford scores between 15 to 25, became 40 plus after treatment.
Conclusion: Haematogenous ozone, intraarticular hydrozone, and low dose DMARDs are an excellent combination to achieve hip preservation, avoid surgery, and ensure reversal of Hip AVN and produces results superior to core decompression, and Total Hip Replacement, while preserving the patient’s natural hip joint.
Keywords: Hydrozone; Hydrogen
Citation: L Prakash., et al. “Hydrozone Gaseous Arthrodiastesis, EBOO/MAHT, and Low Dose Methotrexate in Ficat Grade 3/4 Avascular Necrosis of Hip Joints in Young Patients".Acta Scientific Orthopaedics 8.6 (2025): 28-38.
Copyright: © 2025 L Prakash., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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