Abstract
Our retrospective study assessed the effects of treatment of early stage ONFH with extracorporeal shock wave therapy. 335 patients (528 hips) were treated with shockwave therapy in our institution. Each patient underwent two sessions. The hips were divided into two groups according to whether the lateral pillar of the femoral head (LPFH) was preserved: LPFH and non-LPFH groups. Patients were followed up at 3, 6, and 12 months after the treatment. Most of the patients (83.9% hips) demonstrated pain reduction and improved mobility of the treated joint (visual analogue scale score, P = 0.00006; Harris hip score, P = 0.00091). During the follow-up period, 16 hips failed following femoral head collapse and required hip arthroplasty (2 hips in LPFH group and 14 hips in non-LPFH group). The lesion size decreased after ESWT. However, the differences were statistically not significant (LPFH group, P = 0.091; non-LPFH group, P = 0.087). A significant reduction in bone marrow edema was observed after treatment (LPFH group, P = 0.007; non-LPFH group, P = 0.016). High-energy extracorporeal shock wave therapy resulted in considerable improvement in early stage ONFH, which can effectively relieve pain and improve the function of the hip.
Highlights
The osteonecrosis of the femoral head (ONFH) is common in young adults, and it is the leading cause of hip joint replacements in many Asian countries including China [1]
Most patients described the daily life function as significantly improved, but the Harris score after the removal of the pain score increased slightly from 36.1 ± 7.9 before treatment to 40.6 ± 13.5 after treatment, and the difference was not statistically significant (P > 0.05), which indicated that its function improvement was mainly due to the reduction of pain
The natural history of ONFH usually results in collapse of the femoral head and deterioration with degenerative changes of the hip, and surgery becomes inevitable [4, 22]
Summary
The osteonecrosis of the femoral head (ONFH) is common in young adults, and it is the leading cause of hip joint replacements in many Asian countries including China [1]. The disease remains well-known, it is not fully understood because of the difficulty in early diagnosis, miscellaneous etiologies, unclear pathogenesis, and undetermined successful treatment [2]. The ONFH adults with Stages I to III present an overall therapeutic challenge [6]. Conservative treatments such as NSAID, physical therapy, and protected weight bearing [3, 5] are generally unsuccessful, and a variety of surgery procedures varying according to the stage of the disease on image studies are indicated in symptomatic hips [3,4,5,6,7,8]. There is an unmet need for an effective and noninvasive alternative method for treating ONFH
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