Abstract
BackgroundWe aimed to evaluate the role of extracorporeal shockwave therapy (ESWT) in improving osteonecrosis of the femoral head (ONFH).MethodsWe searched studies focusing on the role of ESWT in ONFH using PubMed, Embase, the Cochrane Library, WanFang, VIP, and CNKI databases updated up to July 28, 2017, without language restriction. Standardized mean difference (SMD) values and 95% confidence intervals (95% CIs) were pooled to compare the pain score and Harris hip score for ESWT treatment and other treatment strategies.ResultsFour articles, including 230 ONFH patients, were eligible for the meta-analysis. No significant differences were found in the pain score (SMD = − 1.0104; 95% CI − 2.3279–0.3071) and Harris hip score (SMD = 0.3717; 95% CI − 0.3125–1.0559) between the two groups before treatment. After treatment, significant differences were found between the experimental and control groups in the pain score (SMD = − 2.1148; 95% CI − 3.2332–0.9965) and Harris hip score (SMD = 2.1377; 95% CI 1.2875–2.9880). There were no significant differences in pain score before and after treatment between the two groups (SMD = − 0.7353; 95% CI − 2.1272–0.6566), but significant differences were found in the Harris hip score (SMD = 1.2969; 95% CI 0.7171–1.8767).ConclusionFor patients at an early stage, ESWT may be safe and effective for relief of pain and improvement of motor function.
Highlights
We aimed to evaluate the role of extracorporeal shockwave therapy (ESWT) in improving osteonecrosis of the femoral head (ONFH)
A combination of Medical Subject Headings (MeSH) terms and free-text keywords were used for study selection: (“ESWT” OR “Extracorporeal shock wave”) AND (“osteonecrosis” OR “Osteonecrosis” OR “femoral head necrosis” OR “Osteonecrosis of the femoral head (ONFH)” OR “Osteonecrosis of the Femoral Head” OR “avascular necrosis of femoral head” OR “necrosis of the femoral head” OR “avascular necrosis of bone” OR “Kienbock disease” OR “Aseptic necrosis of bone”)
Selection criteria Literature focusing on the efficacy of ESWT in patients with femoral head necrosis were included in the meta-analysis
Summary
We aimed to evaluate the role of extracorporeal shockwave therapy (ESWT) in improving osteonecrosis of the femoral head (ONFH). The treatment of ONFH “Joint-preserving” treatments, including both surgical (such as core decompression, trochanteric rotational osteotomy, and vascularized bone grafts) and conservative approaches [extracorporeal shock wave therapy (ESWT) and pulsed electromagnetic field] have been developed to prevent progression of ONFH [7, 8]. ESWT is used in physical therapy, orthopedics, urology, and cardiology, and a previous study demonstrated that the technology can successfully treat ONFH [9]. No significant difference in efficacy was found between ESWT and core decompression in a study by Wang et al [10]. A study by Chen and colleagues demonstrated better outcomes with ESWT than with physical
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