Comparative effectiveness of complex physiotherapeutic treatment of patients in the early stages of avascular necrosis of the femoral head

Abstract

In the late stages of avascular necrosis of the femoral head (ANFH), total hip arthroplasty (THA) is a non-alternative treatment method. In the early stages, methods of conservative treatment show some effectiveness. Among them, most often there is evidence of the effectiveness of physiotherapy options. Of this study is the development and study of a method of complex non-surgical treatment of ANFH based on a combination of physiotherapy and phytotherapy methods. We examined 60 patients with early stages of ANFH, who underwent courses of complex treatment. Patients of the primary group received a complex, including: exposure to acupuncture points in the area of hip joint (HJ) with low-frequency currents using the Osteon-1 apparatus in combination with phytoapplications, HJ massage, special physiotherapy exercises. Unloading the HJ (walking on crutches) was mandatory component. Patients in the control group were treated using a complex including: manual massage of HJ, the use of sinusoidally modulated currents and ultraphonophoresis of hydrocortisone on the affected joint. In order to assess the dynamics of the clinical and functional state of HJ before and after the treatment, Harris questionnaire, radiography, ultrasound densitometry, and laser Doppler imaging were used. Quality of life was assessed using the SF36 questionnaire. The full course of treatment was 1 month. Long-term results were studied after 1 year by the questionnaire method. In patients of both groups, a positive dynamics of the clinical and functional state of the joints was registered, but higher statistically significant indicators were obtained in the primary group. Moreover, in a significant number of patients (in 95% of cases), positive clinical results persisted throughout the year. The use of a complex of treatment based on physiotherapy and a combination of physiotherapy and phytotherapy makes it possible for us to obtain positive clinical and functional dynamics of the state of the joints and an increase in the quality of life in patients with ANFH.