High-energy extracorporeal shock wave therapy for nontraumatic osteonecrosis of the femoral head

Kai Xie,Qingwei Jia,Zhenan Zhu,Yuanqing Mao,Kerong Dai,Mengning Yan,Xinhua Qu

doi:10.1186/s13018-017-0705-x

Abstract

BackgroundNontraumatic osteonecrosis of the femoral head (ONFH) is treated with a series of methods. High-energy extracorporeal shock wave therapy (ESWT) is an option with promising mid-term outcomes. The objective of this study was to determine the long-term outcomes of ESWT for ONFH.MethodsFifty-three hips in 39 consecutive patients were treated with ESWT in our hospital between January 2005 and July 2006. Forty-four hips in 31 patients with stage I–III nontraumatic ONFH, according to the Association Research Circulation Osseous (ARCO) system, were reviewed in the current retrospective study. The visual analog pain scale (VAS), Harris hip score, radiography, and magnetic resonance imaging were used to estimate treatment results. The progression of ONFH was evaluated by imaging examination and clinical outcomes. The results were classified as clinical success (no progression of hip symptoms) and imaging success (no progression of stage or substage on radiography and MRI).ResultsThe mean follow-up duration was 130.6 months (range, 121 to 138 months). The mean VAS decreased from 3.8 before ESWT to 2.2 points at the 10-year follow-up (p < 0.001). The mean Harris hip score improved from 77.4 before ESWT to 86.9 points at the 10-year follow-up. The clinical success rates were 87.5% in ARCO stage I patients, 71.4% in ARCO stage II patients, and 75.0% in ARCO stage III patients. Imaging success was observed in all stage I hips, 64.3% of stage II hips, and 12.5% of stage III hips. Seventeen hips showed progression of the ARCO stage/substage on imaging examination. Eight hips showed femoral head collapse at the 10-year follow-up. Four hips in ARCO stage III and one hip in ARCO stage II were treated with total hip arthroplasty during the follow-up. Three were performed 1 year after ESWT, one at 2 years, and one at 5 years.ConclusionsThe results of the current study indicated that ESWT is an effective treatment method for nontraumatic ONFH, resulting in pain relief and function restoration, especially for patients with ARCO stage I–II ONFH.

Highlights

Nontraumatic osteonecrosis of the femoral head (ONFH) is treated with a series of methods
The outcomes of extracorporeal shock wave therapy (ESWT) were different in patients with different Association Research Circulation Osseous (ARCO) stages and pathogeny at the final follow-up (Table 3)
The clinical success was defined as no progression of hip symptoms, which was observed in 87.5% of ARCO stage I patients, 71.4% of ARCO stage II patients, and 75.0% of ARCO stage III patients

Summary

Introduction

Nontraumatic osteonecrosis of the femoral head (ONFH) is treated with a series of methods. Highenergy extracorporeal shock wave therapy (ESWT) is an option with promising mid-term outcomes. The objective of this study was to determine the long-term outcomes of ESWT for ONFH. Osteonecrosis of the femoral head (ONFH) is mainly associated with significant hip pain and dysfunction in young adults. ONFH was reported to affect 20,000 patients each year in America [1]. Most patients without an effective treatment in the early stage require hip joint replacement. Postcollapse ONFH is one of the most common reasons for primary total hip arthroplasty in many countries [2, 4]. Given the relatively young age at the time of presentation, it is reasonable to preserve the native hip in patients with early-stage ONFH. Several different jointpreserving operative interventions have been reported with promising outcomes in the past decades, including core decompression, osteotomy, and vascularized/nonvascularized bone grafting

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