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Körpinar Ş, Esen E, Siddikoğlu D, Aylanç N. Prevalence of Dysbaric Osteonecrosis in Professional

Divers and Analysis of Influencing Factors. Undersea Hyperb Med. 2026 Third Quarter; 53(3):423-

432.

Introduction: Dysbaric osteonecrosis (DON) is an occupational hazard that can lead to joint deformity in

professional divers who represent the young workforce. This study aimed to determine the prevalence

of DON in professional divers and to investigate the factors that would justify requests for magnetic

resonance imaging (MRI) as part of periodic fitness-to-dive examinations, particularly in asymptomatic

cases.

Methods: In this retrospective study, medical records and imaging data of 120 professional divers who

underwent routine fitness-to-dive evaluations between June 2018 and March 2024 were reviewed. Both

X-rays and MRI scans were assessed for signs of osteonecrosis. Demographic data, diving profiles, clinical

history, and biochemical parameters were analyzed to identify potential risk factors associated with DON.

Results: Dysbaric osteonecrosis was identified in 10 out of 120 divers (8.3%). The most affected

anatomical region was the right humerus. MRI detected 9 of 10 DON cases, while X-rays identified only

one. Statistically significant risk factors for DON included a cumulative diving duration exceeding 900

hours, weekly diving time over 15 hours, diving depths beyond 35 meters, and diving experience greater

than 9.5 years. A previous history of decompression sickness (DCS) and a prior diagnosis of DON were

also strongly associated with current lesions. MRI demonstrated significantly higher sensitivity compared

to radiography (p < 0.0001).

Discussion: MRI is considerably more sensitive than conventional radiography in detecting DON,

particularly in its early stages. Routine MRI screening may be beneficial for divers with prolonged or

intense diving exposure or a history of decompression-related complications, enabling early diagnosis

and timely intervention to prevent long-term sequelae.

Keywords: avascular necrosis, decompression sickness, dysbaric osteonecrosis, hyperbaric exposure, MRI,

professional divers, X-ray