Clinical and Radiological Outcomes of Extracorporeal Shock Wave Therapy in Early-Stage Femoral Head Osteonecrosis

Abstract

Objective Femoral head osteonecrosis is a progressive clinical condition with significant morbidity and long-term disability. Several treatment modalities including both surgical and nonsurgical options have been used with variable levels of success. High-energy extracorporeal shock wave therapy is a nonoperative treatment option that has been described for early-stage disease. We aimed to assess the functional and radiological outcomes of extracorporeal shockwave therapy (ESWT) in the treatment of osteonecrosis of the femoral head (ONFH). Methods Thirty-three hips of 21 patients were included in this study. Adult patients with ONFH of any etiology and in the precollapse stage were included. Clinical (visual analogue scale [VAS] and Harris hip score [HHS]) and radiological (plain radiographs and magnetic resonance imaging [MRI]) evaluations were performed before and after intervention. We used 3000–4500 pulses in a single session performed under general anesthesia. Results At an average of 8 months after ESWT, pain scores and HHS were significantly improved compared with the preintervention scores (p<0.001). The overall clinical outcomes were improved in 21 hips (63.3%), unchanged in 5 hips (15.15%), and worsened in 7 hips (21.2%). A trend toward a decrease in the size of the ONFH was observed although not of clinical significance (p=0.235). MRI revealed significant resolution of bone marrow edema (p<0.003). Regression was observed in 9 lesions (42.9%) and progression in 1 lesion (4.7%); no change was observed in the remaining 23 lesions (52.4%). Conclusion ESWT is a viable noninvasive treatment option for early-stage ONFH. It significantly improves clinical outcomes and may halt or delay the radiographic progression of the disease in the precollapse stage.

Osteonecrosis of the Femoral Head: Can Arthroplasty be Avoided—A Brief Review of Common Interventions

“…51 Nevertheless, an appreciable reduction in bone marrow edema from grades 3-4 to grades 1-2 was seen. 51 Long-term outcomes of shockwave therapy reported by Xie et al also demonstrated favorable outcomes among 39 patients with predominately stage II disease. 49 After the procedures, MRIs were taken during follow-ups at 6 months, 12 months, and then once a year.…”

“…Patients were then followed up at 6 weeks and quarterly thereafter. 51 Algarni and Moallem observed substantial improvements in pain and HHS scores at 8 months, although MRI imaging demonstrated no statistically significant decrease in lesion size (p ¼ 0.23). 51 Nevertheless, an appreciable reduction in bone marrow edema from grades 3-4 to grades 1-2 was seen.…”

“…51 Algarni and Moallem observed substantial improvements in pain and HHS scores at 8 months, although MRI imaging demonstrated no statistically significant decrease in lesion size (p ¼ 0.23). 51 Nevertheless, an appreciable reduction in bone marrow edema from grades 3-4 to grades 1-2 was seen. 51 Long-term outcomes of shockwave therapy reported by Xie et al also demonstrated favorable outcomes among 39 patients with predominately stage II disease.…”

Efficacy and safety of treating symptomatic, primary focal osteochondral lesions of the patella with a combination of intra-articular injection of hyaluronic acid (HAi) and radial extracorporeal shock wave therapy (rESWT) or HAi alone: a retrospective two-cohort study

“…Over the past decades extracorporeal shock wave therapy (ESWT) has emerged as a promising treatment for many musculoskeletal conditions [14][15][16]. In particular, ESWT has shown therapeutic value for treating avascular necrosis of the femoral head [17][18][19][20] and osteochondral lesions of the talus [21].…”

Review Over the Therapeutic Benefit of Extracorporeal Shockwave Therapy in Orthopaedic Patients

“…Shockwaves are documented to stimulate bone regeneration, and it has been suggested that it may also induce specifi c signals for growth and maturation of the mesenchymal progenitors of the bone marrow. At the same time, shockwaves produce increased concentrations of free radicals [51][52][53][54][55] . A link has been detected between morphogenic proteins (BMP) and shockwave activity regarding bone regeneration.…”