Ozone therapy in femoral head necrosis: a perspective on biomarker-guided treatment rationalization and mechanistic exploration.

Femoral head necrosis (FHN) is a progressive and disabling disorder caused by compromised blood supply to the femoral head. Current treatments primarily aim to slow progression. However, they often fail to reverse early-stage necrosis or reliably prevent disease advancement. Importantly, most approaches lack precise molecular targets for early intervention. Ozone therapy has emerged as a potential option because of its pleiotropic biological effects, such as modulating oxidative stress, improving microcirculation, and exerting anti-inflammatory activity. However, its mechanisms remain poorly understood. Clinical evidence is limited and inconsistent, and the absence of standardized protocols hinders evidence-based implementation. To address these gaps, this perspective proposes biomarkers as a translational bridge linking ozone-induced biological responses to FHN pathology. We further outline a dynamic, biomarker-guided framework through which ozone therapy can evolve from an empirical intervention into a mechanism-informed, personalized, and more standardized precision strategy. This approach offers a scientifically grounded pathway for advancing the clinical management of FHN.