Cocktail therapy for femoral head necrosis of the hip

Hsu, Shan-Ling; Wang, Ching‐Jen; Lee, Mel Shiuann-Sheng; Chan, Yi‐Sheng; Huang, Chung‐Cheng; Yang, Kuender D.

doi:10.1007/s00402-009-0918-5

Cited by 47 publications

(56 citation statements)

References 32 publications

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“…Group A consisted of 28 patients (50 hips) who received cocktail therapy, and group B consisted of 35 patients (48 hips) who received only ESWT. After a minimum follow-up of 2 years, the overall results showed 74% improved, 16% unchanged and 10% [13,14].…”

Section: Eswt and Cocktail Therapy For Onfhmentioning

confidence: 91%

“…All patients returned to work as healthcare providers and no one required surgical intervention including hip replacement. In a later study of sixty three patients (98 hips) that were randomly divided into two groups for cocktail therapy and ESWT (0.474 mJ/mm 2 energy flux density, 6000 impulses) alone [13]. Group A consisted of 28 patients (50 hips) who received cocktail therapy, and group B consisted of 35 patients (48 hips) who received only ESWT.…”

Section: Eswt and Cocktail Therapy For Onfhmentioning

confidence: 99%

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Extracorporeal shockwave therapy for avascular necrosis of femoral head

Wang

Cheng

Huang

et al. 2015

International Journal of Surgery

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The etiology of osteonecrosis of the femoral head (ONFH) is multifactorial. Treatment of ONFH is disease stage dependent. For early stages, femoral head preservation procedures are preferred including core decompression, muscle pedicle grafting and de-rotational osteotomy. Core decompression with bone grafting is considered the gold standard. However, the results are inconsistence and unpredictable. An effective non-invasive method of treatment is imperative. Recently, extracorporeal shockwave therapy (ESWT) has shown beneficial effects in ONFH. ESWT improves pain and function of the hip and regression of the ONFH lesion. ESWT is more effective than core decompression with or without bone grafting, cocktail therapy that combined HBO, ESWT and oral alendronate is shown effective for patients with early osteonecrosis. The purpose of the article is to review, update and summarize the clinical treatment of ONFH using shockwave therapy.

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Section: Eswt and Cocktail Therapy For Onfhmentioning

confidence: 91%

Section: Eswt and Cocktail Therapy For Onfhmentioning

confidence: 99%

Extracorporeal shockwave therapy for avascular necrosis of femoral head

Wang

Cheng

Huang

et al. 2015

International Journal of Surgery

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“…They concluded that ESWT is an effective treatment with or without the concurrent use of alendronate. Similarly, Hsu et al [29] have compared the outcomes of ESWT alone and as part of a cocktail treatment consisting of ESWT, hyperbaric oxygen, and alendronate. The authors reported improvement in 79.2% of the patients in the ESWT group, without a significant difference between both groups.…”

Section: Discussionmentioning

confidence: 99%

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

Algarni

Moallem

2018

Advances in Orthopedics

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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.

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“…Medical therapies as well as nonpharmacological therapies, including modified weight bearing, hyperbaric oxygen and extracorporeal shock wave therapy, have been the subject of multiple investigations, including several prospective studies. 18,[32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] Bisphosphonates have received specific attention owing to their known effect of decreasing osteoclast-mediated bone turnover that theoretically could prevent subchondral bone collapse. A randomized controlled trial assessing 54 hips reported significantly lower rates of disease progression and need for arthroplasty in patients treated with bisphosphonates for 2 months.…”

Section: Discussionmentioning

confidence: 99%

Treatment with acetylsalicylic acid prevents short to mid-term radiographic progression of nontraumatic osteonecrosis of the femoral head: a pilot study

et al. 2015

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Treatment with acetylsalicylic acid prevents short to mid-term radiographic progression of nontraumatic osteonecrosis of the femoral head: a pilot study Background: Nontraumatic osteonecrosis of the femoral head (ONFH) is a progressive disease in young adults producing substantial morbidity and frequently resulting in total hip arthroplasty. Although hip-preserving surgical procedures represent the current mainstay of treatment for early disease, medical therapies targeting specific pathways in the ONFH pathogenesis could help prevent disease progression while producing less morbidity. Acetylsalicylic acid (ASA) is a promising alternative to other therapies for ONFH owing to its anti-inflammatory and antithrombotic mechanisms of action and its relatively benign side effect profile. Methods:We followed a prospective cohort of 10 patients (12 hips) with precollapse ONFH who were given ASA to prevent disease progression. Their outcomes were compared with those of a historic control group taken from the literature.Results: Progression occurred in 1 of 12 (8%) patients taking ASA compared with 30 of 45 (66.6%) controls (p = 0.002) at a mean follow-up of 3.7 years. Patients taking ASA also tended to exhibit decreased femoral head involvement at the end of therapy. Conclusion:This hypothesis-generating study leads us to believe that ASA may be a simple and effective treatment option for delaying disease progression in patients with early-stage ONFH.Contexte : L'ostéonécrose non traumatique de la tête fémorale (ONTF) est une maladie progressive qui affecte les adultes jeunes, s'accompagne d'une morbidité substantielle et mène souvent à une arthroplastie totale de la hanche. Même si les interventions chirurgicales visant à préserver la hanche représentent la pierre angulaire actuelle du traitement pour la maladie au stade précoce, les traitements médica-menteux qui ciblent les voies spécifiques de la pathogenèse de l'ONTF pourraient contribuer à prévenir la progression de la maladie tout en atténuant la morbidité. L'acide acétylsalicylique (AAS) est une solution de rechange prometteuse aux autres traitements indiqués pour l'ONTF en raison de ses propriétés anti-inflammatoires et antithrombotiques et de son profil d'innocuité relativement bénin.Méthodes : Nous avons suivi une cohorte prospective de 10 patients (12 hanches) présentant une ONTF au stade précollapsus qui ont reçu de l'AAS pour prévenir la progression de la maladie. Leurs résultats ont été comparés à ceux d'un groupe témoin historique de patients décrits dans la littérature.Résultats : La progression a affecté 1 patient sur 12 (8 %) traités par AAS, contre 30 témoins sur 45 (66,6 %) (p = 0,002) après un suivi moyen de 3,7 ans. Les patients sous AAS avaient tendance à présenter une atteinte moins prononcée de la tête fémorale à la fin du traitement. Conclusion :Cette étude exploratoire nous amène à croire que l'AAS pourrait être une option thérapeutique simple et efficace pour retarder la progression de la maladie chez les patients au stade précoce d'une ONTF.

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Cocktail therapy for femoral head necrosis of the hip

Abstract: Long-term results are needed to determine whether or not the synergistic effects of ESWT, HBO and alendronate over ESWT alone exist in early hip necrosis.

Cited by 47 publications

References 32 publications

Extracorporeal shockwave therapy for avascular necrosis of femoral head

Extracorporeal shockwave therapy for avascular necrosis of femoral head

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

Treatment with acetylsalicylic acid prevents short to mid-term radiographic progression of nontraumatic osteonecrosis of the femoral head: a pilot study

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