Hyperbaric Oxygen Therapy Enhances Autologous Bone Graft Integration: A Meta-Analysis New!

ABSTRACT

Background: Autologous bone grafting is essential in reconstructive surgeries, particularly orthopedic and maxillofacial applications, but graft integration can be challenging in high-risk patients. Hyperbaric Oxygen Therapy (HBOT) has been proposed to enhance bone graft integration by stimulating osteogenesis and vascularization. This systematic review and meta-analysis evaluated the efficacy of HBOT in promoting autologous bone graft integration and identified contexts where HBOT may be most beneficial.

Methods: A systematic search identified 11 studies meeting inclusion criteria, seven providing quantitative data for meta-analysis. The primary meta-analysis and an orthopedic-specific subgroup analysis used random-effects models to calculate pooled Standardized Mean Differences (SMD) and assess heterogeneity (I²).

Results: HBOT demonstrated a significant positive effect on bone graft integration in the primary analysis (SMD: 1.476, 95% CI: 0.814–2.138). The orthopedic subgroup showed a stronger, consistent effect (SMD: 1.995, 95% CI: 1.117–2.873) with low heterogeneity (I² = 3.361%). Observational studies suggest potential benefits for maxillofacial grafts, but a lack of controlled data limits the evidence. One cranial study reported an anomalous negative result.

Conclusions: HBOT significantly enhances autologous bone graft integration, particularly in orthopedic applications and high-risk patients. Its ability to stimulate osteogenesis and vascularization highlights its value as an adjunctive therapy in complex reconstructions. However, the reliance on animal models and limited human data in maxillofacial applications underscore the need for further research and protocol standardization.

Keywords: autologous bone graft; bone integration; hyperbaric oxygen therapy; vascularization