Osteonecrosis of Femoral Head Treated with Extracorporeal Shock Wave Therapy: Analysis of Short-term Clinical Outcomes of Treatment with Radiologic Staging

Abstract

PurposeTo evaluate clinical results of extracorporeal shock wave therapy (ESWT) with radiographic staging on patients with avascular necrosis of femoral head (AVNFH).Materials and MethodsWe evaluated 24 patients diagnosed with AVNFH (32 hip joints) who were treated with ESWT from 1993 to 2012. Average follow-up period was 27 months, and the average age of patients was 47.8 years. The Association Research Circulation Osseous (ARCO) system was used to grade radiographic stage prior to treatment. For this study patients were divided into two groups based on their ARCO stage, group 1 (ARCO stages I and II) and group 2 (ARCO stage III). Comparative analyses were done between the two groups using the visual analogue scale (VAS) score and the Harris hip score (HHS) at pre-treatment and 3, 6, 12, and 24 months after treatment. Failure was defined when radiographic stage progressed or arthroplasty surgery was needed due to clinical exacerbation.ResultsBoth groups showed clinical improvements with VAS scoring at final follow-up (group 1: median 7 to 1.5, P<0.001; group 2: mean 7 to 4, P=0.056). Using HHS, group 1 showed a significant improvement (from 65.5 to 95 [P<0.001]), while no significance was observed for group 2 (P=0.280). At final follow-up, 3 hips from group 1 and one hip from group 2 showed radiographic improvement; however, two patients underwent total hip arthroplasty due to persistent pain and dysfunction.ConclusionESWT can be considered as an interventional option before surgical treatment in patients with not only early stage AVNFH but also with mid stage.

Extracorporeal shockwave therapy in osteonecrosis of femoral head

“…It must be pointed out that in this study they did not undertake MRI examination and the definition of cure was disappearance of clinical symptoms. In 2012, Vulpiani et al [23] [29] also divided patients on the basis of ARCO stage and obtained similar results. Kusz et al [24] demonstrated considerable enhancement of quality of life in ONFH patients after ESWT; however, they only followed up patients for 6 weeks.…”

“…Eventually, 17 [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] studies were considered to be eligible for this systematic review, 16 [13][14][15][16][17][18][19][20][21][23][24][25][26][27][28][29] of which were published in English and only 1 [22] was published in Chinese. Next, we extracted 3 types of useful data from included studies and imported them into different tables: basic information of included publications ( Table 1); technological details of extracorporeal shockwave therapy ( Table 2) and therapeutic effect assessment indexes of included studies ( Table 3).…”

“…As for the study design, 2 [15,28] were case reports, 9 [13,14,16,[22][23][24][25]27,29] were open label trials, 2 [20,26] were cohorts, and 4 [17][18][19]24] were randomized controlled trials (RCTs). Twelve [13,14,[16][17][18][19][20][21][23][24][25]27] studies were prospective ones and 5 [15,22,26,28,29] were retrospective ones. All patients were diagnosed with ONFH.…”

“…Eleven [13,15,16,20,[22][23][24][26][27][28][29] studies only investigated the effect of extracorporeal shockwave, 4 [14,17,19,25] compared the performance of ESWT with operations (jointpreserving surgeries or endoprosthetic replacement of joint) and 2 [18,21] compared the effect of ESWT with cocktail therapy (ESWT combined with other noninvasive modalities). Sixteen [13][14][15][16][18][19][20][21][22][23][24][25][26][27][28][29] studies presented the visual analog scale (VAS) and/or Harris hip score before and after the treatment as evaluation indicators. Other outcome assessment indexes provided by these literatures included the Western Ontario and McMaster Universities Arthritis Index (WOMAC), the 12item Short Form (SF-12) Survey, magnetic resonance imaging manifestation, the need for surgical intervention as well as numbers of patients with improved, stable and deteriorating conditions.…”

“…Ludwig et al [13] 2001 Nil 28 4000 NR Wang et al [14] 2005 Core decompression and bone-grafting 28 6000 0.62 Lin et al [15] 2006 Nil 28 4000 0.62 Wang et al [18] 2008 Nil 28 6000 0.62 Wang et al [17] 2008 THA 28 6000 0.62 Wong et al [16] 2008 Nil 28 6000 0.62 Chen et al [19] 2009 THA 28 6000 0.62 Wang et al [20] 2009 Nil 28 6000 0.62 Hsu et al [21] 2010 Nil 28 6000 0.62 Kong et al [22] 2010 Nil NR 1200-2500 0.18-0.25 Vulpiani et al [23] 2012 Nil NR 9600 0.5 Kusz et al [24] 2012 Nil NR 7500 0.4 Wang et al [25] 2012 Operation 28 6000 0.62 Gao et al [26] 2015 Nil 13-14 3000-4000 >0.44 Lee et al [29] 2015 Nil 27 6000 NR Ma et al [28] 2016 Nil NR 6000 NR Sun et al [27] 2016 Table 3 Therapeutic effect assessment indexes of included studies.…”