Extracorporeal shock wave therapy for bone marrow edema syndrome in patients with osteonecrosis of the femoral head: a retrospective cohort study

Wenyi, Zhao; Gao, Yuan; Zhang, Shouxiang; Liu, Zhang; He, Lin; Zhang, Dahong; Li, Wei; Meng, Qinggang

doi:10.1186/s13018-020-02159-7

Cited by 10 publications

(9 citation statements)

References 42 publications

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“…The etiology and pathogenesis of BMES are unclear; histologic ndings suggest that abnormal vascular proliferation and increased focal bone conversion are accepted hypotheses for BMES [22] .ESWT is now widely used in musculoskeletal disorders, and the effectiveness of ESWT has been recognized, with literature demonstrating the e cacy of ESWT in the treatment of BMES caused by osteonecrosis of the femoral head (ONFH) by relieving pain and achieving functional recovery [23] .…”

Section: Discussionmentioning

confidence: 99%

Efficacy of extracorporeal shock wave therapy in the treatment of bone marrow edema in different parts of the knee joints

Hu,

Liu,

et al. 2024

Preprint

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Background The purpose of this prospective study was to evaluate the effectiveness of extracorporeal shock wave therapy (ESWT) in reducing symptoms and normalizing imaging features in periprosthetic bone marrow edema syndrome (BMES) of the knee. Methods The clinical data of 42 patients with knee bone marrow edema syndrome who attended the Department of Joint Surgery of the Affiliated Hospital of Southwest Medical University from January 2021 to December 2023 were collected, and they were divided into three groups according to the different parts of the knee edema: the femur group (26 cases), the tibia group (9 cases), and the patella group (7 cases). The visual analog scale (VAS) of pain, the knee score (HSS) of the Hospital for Special Surgery of the United States, and the area of BME on magnetic resonance imaging (cm2 ) were observed before and after three months of shock wave treatment in each group. Results Overall VAS score decreased from 5.40 ± 1.624 to 1.57 ± 1.328 before treatment (P < 0.05), and HSS score increased from 83.05 ± 9.063 to 93.00 ± 4.129 before treatment (P < 0.05); the area of BMES decreased from 3.876 ± 3.277 cm2 before treatment to 1.294 ± 0.352 cm2 (P < 0.05) before and after treatment. There was no significant difference between the three groups before and after treatment. (P > 0.05) Conclusion Overall ESWT is effective in the treatment of periprosthetic BMES, leading to a decrease in VAS scores, an increase in HSS scores, and a significant decrease in the area of bone marrow edema on T2WI of MRI (except for the patellofemoral group where the decrease in the area of bone marrow edema was not statistically significant, but the overall trend was downward).

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Section: Discussionmentioning

confidence: 99%

Efficacy of extracorporeal shock wave therapy in the treatment of bone marrow edema in different parts of the knee joints

Hu,

Liu,

et al. 2024

Preprint

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“…This finding suggests that, as compared to pharmacotherapy, ESWT avoids the lack of targeted treatment and limits bone marrow edema induced by early ONFH. During treatment, fESWT promotes blood circulation and reduces inflammation, thereby limiting pain associated with ONFH[ 14 , 37 , 38 ]. Treatment with traditional NSAIDs does not exhibit these features.…”

Section: Discussionmentioning

confidence: 99%

Effects of individual shock wave therapy vs celecoxib on hip pain caused by femoral head necrosis

Zhu¹,

Yan²,

Xiao³

et al. 2023

World J Clin Cases

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BACKGROUND Celecoxib has been used to treat hip discomfort and functional difficulties associated with osteonecrosis of the femoral head (ONFH), although significant adverse reactions often follow long-term use. Extracorporeal shock wave therapy (ESWT) can delay the progression of ONFH, alleviate the pain and functional limitations it causes, and avoid the adverse effects of celecoxib. AIM To investigate the effects of individual ESWT, a treatment alternative to the use of celecoxib, in alleviating pain and dysfunction caused by ONFH. METHODS This was a randomized, controlled, double-blinded, non-inferiority trial. We examined 80 patients for eligibility in this study; 8 patients were excluded based on inclusion and exclusion criteria. A total of 72 subjects with ONFH were randomly assigned to group A ( n = 36; celecoxib + alendronate + sham-placebo shock wave) or group B ( n = 36; individual focused shock wave [ESWT based on magnetic resonance imaging three-dimensional (MRI-3D) reconstruction] + alendronate). The outcomes were assessed at baseline, at the end of treatment, and at an 8-wk follow-up. The primary outcome measure was treatment efficiency after 2 wk of intervention using the Harris hip score (HHS) (improvement of 10 points or more from the baseline was deemed sufficient). Secondary outcome measures were post-treatment HHS, visual analog scale (VAS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. RESULTS After treatment, the pain treatment efficiency of group B was greater than that of group A (69% vs 51%; 95%CI: 4.56% to 40.56%), with non-inferiority thresholds of -4.56% and -10%, respectively. Furthermore, the HHS, WOMAC, and VAS scores in group B dramatically improved during the follow-up period as compared to those in group A ( P < 0.001). After therapy, the VAS and WOMAC in group A were significantly improved from the 2 nd to 8 th wk ( P < 0.001), although HHS was only significantly altered at the 2 wk point ( P < 0.001). On the 1 st d and 2 nd wk after treatment, HHS and VAS scores were different between groups, with the difference in HHS lasting until week 4. Neither group had severe complications such as skin ulcer infection or lower limb motor-sensory disturbance. CONCLUSION Individual shock wave therapy (ESWT) based on MRI-3D reconstruction was not inferior to celecoxib in managing hip pain and restrictions associated with ONFH.

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“…Zhao et al [54] compared ESWT treatment with intravenous prostacyclin and bisphosphonate for the treatment of primary bone marrow syndrome in avascular necrosis of the femoral head. They demonstrated ESWT having significant improvement in VAS and WOMAC scores at 1,3 and 6 month follow ups [54].…”

Section: Bone Edema and Nonunion Fracturesmentioning

confidence: 99%

Untitled

2024

EPMR

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Since its inception with lithotripsy over 3 decades ago, Extracorporeal Shockwave Therapy (ESWT) is a globally used treatment for musculoskeletal injuries. ESWT is a non-invasive anabolic modality promoting neovascularization and angiogenesis by inducing the body's own secretion of growth factors and inflammatory mediators. Using machine-based energy via acoustic waves, ESWT facilitates bone and connective tissue metabolism and homeostasis with multiple therapeutic applications. ESWT provides analgesia via denervation and reinnervation of sensory nerves and disruption of C-Fibers. It has demonstrated safety and efficacy in a wide range of upper and lower extremity musculoskeletal conditions involving soft tissue, tendon, and bone. Given the universal increased incidence of musculoskeletal pain, physicians are seeking minimally invasive and cost-effective tools. Along with the emergence of orthobiologic injections, shockwave is gaining popularity by leveraging the body's inherent ability to self-heal. This article provides a narrative review of ESWT for chronic musculoskeletal injuries and its potential as a biologic tool.

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Extracorporeal shock wave therapy for bone marrow edema syndrome in patients with osteonecrosis of the femoral head: a retrospective cohort study

Cited by 10 publications

References 42 publications

Efficacy of extracorporeal shock wave therapy in the treatment of bone marrow edema in different parts of the knee joints

Efficacy of extracorporeal shock wave therapy in the treatment of bone marrow edema in different parts of the knee joints

Effects of individual shock wave therapy vs celecoxib on hip pain caused by femoral head necrosis

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