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Abstract
ABSTRACT Introduction This study aims to determine whether ESWT (extracorporeal shock wave therapy) affects ONFH (osteonecrosis of femoral head) in clinical outcomes and radiography outcomes. Method Two authors independently search the papers on the treatment of femoral head necrosis with extracorporeal shock wave in CNKI (China National Knowledge Infrastructure), VIP (China Science and Technology Journal Database), CSPD (China Science Periodical Database), Pubmed, Embase, and Springer databases. Search period from the inception dates to 2 June 2020 and have no limitations in language; two authors independently conducted a quality evaluation and data extraction for included studies and performed a meta-analysis with data extracted and calculate by using RevMan5. Registration number: CRD42020213580. Result Nine articles with 409 patients are included in this meta-analysis. The pooled results of HHS (Harris hip score) in eight studies with 337 hips show that ESWT achieves higher Harris scores compared to before treatment (MD = −19.95; 95% CI: −26.27, −13.64) and the difference is statistically significant (p < 0.01). The pooled results of VAS (visual analogue score) in seven studies with 253 hips show that ESWT achieves lower VAS compared to baseline (MD = 2.77; 95% CI: 1.88, 3.65) and the difference is statistically significant (p < 0.01). The pooled results of lesion of MRI with 164 hips show that ESWT decreases the lesion area of MRI (SMD = 1.03; CI: 0.75,1.30) and the difference is statistically significant (p < 0.01). Conclusion ESWT has an effect on pain relief and has a limited effect on motion function. Its effect may be better than surgical groups (core decompression and core decompression with bone grafting). But it cannot decrease the lesion area of the femoral head on MRI and stop disease progression.
Highlights
This study aimed to determine whether extracorporeal shock wave therapy (ESWT) has an efficient effect on osteonecrosis of femoral head (ONFH) in clinical outcomes and radiography outcomes
The pooled results of visual analogue score (VAS) in seven studies with 253 hips show that ESWT achieved lower VAS compared to baseline (MD= 2.77;95%confidence intervals (CI): 1.88, 3.65;), the differences were statistically significant (p
To evaluate ESWT's effect on patients of ONFH and its long-term efficacy, we identified all suitable clinical trials from the electronic database and conducted this meta-analysis thoroughly to probe the influence of ESWT in Harris hip score (HHS) and VAS and the changes of lesion area of the femoral head on MRI
Summary
This study aimed to determine whether ESWT (extracorporeal shock wave therapy) has an efficient effect on ONFH (osteonecrosis of femoral head) in clinical outcomes and radiography outcomes. Degenerative changes of the hip joint and the collapse of the femoral head and degenerative changes of the hip joint occur later in the disease. It is important for young patients in precollapse stage to keep the femoral head intact considering the limited period of the use of prosthesis. Current treatment of hip preservation include core decompression, nonvascularized or vascularized bone-grafting, rotational osteotomy, and muscle pedicle grafting[5,6,7]. These methods have different effects and only treat patients with early necrosis of femoral head.
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