Ozone therapy in conjunction with oral antibiotics as a successful primary and sole treatment for chronic septic prosthetic joint: review and case report

Ozone therapy in conjunction with oral antibiotics as a successful primary and sole treatment for chronic septic prosthetic joint: review and case report

The patient was a 68-year-old white female who underwent bilateral hip replacement surgery on October 27, 2015 for “bone on bone” arthritis. Her recovery process was unre-markable except for lingering discomfort in her right hip. By June 2016, however, the vague discomfort progressed into intermittent pain and swelling of the hip. By mid July 2016, the pain and swelling remained 24/7, and, she developed an intermittent limp. She had to drastically curtail her exercise and yoga. Three separate orthopedic specialists diagnosed joint infection by magnetic resonance imaging (MRI). All told her she would need removal of the prosthetic joint and months of intravenous antibiotic therapy, with an antibiotic impregnated joint spacer. She was terrified of this prospect, causing her to travel 400 miles to our office for ozone therapy. Her history also included 20 root canal restorations in her jaws.

MRI scan showed “very marked synovial thickening/ef-fusion” around the joint which significant edema in the joint and surrounding muscles. She also had osteolysis in Gruen zones #1, #3, #6, and #7. Complete blood count and blood chemistry were unremarkable. Two initial joint aspiration cultures taken by her treating specialists (August 18 and 24, 2016) were negative. This is not necessarily surprising. Even the Mayo Clnic has observed a large number of septic pros-theses inclusive of sinus tracts which were both aerobic and anerobic culture negative.26 Her surgeons still strongly steered her towards prosthesis removal.

She presented to us on August 30, 2016. Pertinent physical findings included temperature of 37.3°C, significant swelling in the entire right hip area, with the physical presence of deep tissue fluid. Her hip range of motion was good on each side. White blood count was 7780 with normal differential. Eryth-rocyte sedimentation rate: 34 mm/hour. Free Triiodothyronine and thyroid stimulating hormone were both normal. Blood chemistry (electrolytes, kidney and liver functions tests) was unremarkable.

An incidental but important physical exam finding was detection of a disturbance in tooth number 6, right upper canine, which had undergone previous endodontic treatment (root canal).

After informed consent was obtained from the patient, she received a single 20 mL of ozone gas, 47 μg/mL, into the right hip (after 1.5 mL 1% preservative free procaine for local anesthesia). This was followed by intravenous HBO3, 140,000 μg “10 pass” ozone as previously described. We performed 3 more HBO3 treatments (140,000 μg) on August 31, September 1, and September 2 before she returned to Los Angeles area, USA.

Additionally, I recommended her for specific radiological evaluation of tooth number 6. The exam later returned with a confirmation of the suspected cavitation/infection.

Upon returning to Los Angeles area, she had two more similar ozone treatments on September 6 and 13.

By September 19, she was called by her orthopedist with confirmation of a positive third culture taken on September 14, 2016. The organisms were 1+ Viridans streptoccus and 1+ Rothia mucilaginosa (both oral bacteria).

When this culture returned, she was prescribed oral Aug-mentin 875 mg twice daily. She began it immediately, and was told emphatically that she needed immediate revision joint surgery as described above.

In the meantime, she had MRI of her jaws revealing 2 sus-picious restorations, including number 6. She had root canal revision surgery on these teeth on October 8 and November 10, 2016.

She discontinued oral antibiotic therapy after 4 weeks (al-though she took a prescribed dose in conjunction the days of the oral root canal surgeries). She reported continuing hyper-baric ozone treatments on October 11, 18, 26, November 3, 9 and 13, with final treatment on December 6, 2016. In all, she had 13 HBO3 treatments delivering 140,000 μg ozone each session, and one intra-articular injection.

The following is her clinical summary in her own words (unchanged) sent by email:

I felt an immediate improvement of the pain and swelling one week after the four 10-Pass IVOzone treatments at Dr. Rowen’s clinic. (For the first 3 days after the [hip] ozone injection, the swelling and pain worsened, and then it subsided to an improved state.) (Author note – this could be attributed to the temporary extra volume (gas) in the joint from the injection as well as reaction to the necrotic waste products released as the heavy bacterial load died off.) On Sept 21, two days after starting Augmentin, the swelling and pain around the infection went down about 80%, very substantial. It was an immediate reaction to the medication, which according to both Dr. K and Dr. P, is never expected from oral Augmentin... especially to have such an extreme improvement so quickly. I believe that my having had six 10-Pass IV Ozone treatments already completed before I started the Augmentin, boosted the effects of the drug and the healing. I started feeling that the infection was completely gone, and have had no signs of swelling or pain, since October 12. However, I decided to wait a few weeks before re testing. I had another MRI of my right hip done on Nov 30, 2016 that showed the infection was completely gone. The doctor at the MRI lab, Dr. M, could not believe it was the same patient and actually called my surgeon, Dr. P, to ask if he had done a revision surgery and had “washed it out”. I also had X-rays and a new blood test at Dr. P’s office on December 2. All of the new tests show that I am infection free. I am now 12½ weeks post the Augmentin course I took, swelling and pain free, taking 1 to 2 mile speed walks on sand, as well as back to my 4X weekly Bikram yoga classes. I intend on continuing the 10-Pass IV Ozone treatments once a month for the next year.

Her hip MRI taken on November 30, 2016 showed signifi-cant to complete resolution of all abnormalities of her previous scan. There remained “mild residual edema signal and changes of osteolysis involving Gruen zones #1 and #7.” Her treating orthopedic physicians were satisfied that the infection was cured. As of February 1, 2018, she remained asymptomatic.

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