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Archives of Orthopaedic and Trauma Surgery

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01-01-2010 | Orthopaedic Surgery

Cocktail therapy for femoral head necrosis of the hip

Authors: Shan-Ling Hsu, Ching-Jen Wang, Mel Shiuann-Sheng Lee, Yi-Sheng Chan, Chung-Cheng Huang, Kuender D. Yang

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 1/2010

Abstract

Introduction

Cocktail therapy consists of extracorporeal shock wave treatment (ESWT), hyperbaric oxygen therapy (HBO) and alendronate. We hypothesized that this combined therapy may produce better results than ESWT alone when treating hip necrosis.

Methods

This prospective, randomized study evaluated the effectiveness of cocktail therapy in early hip necrosis, and then compared it to shock wave treatment alone. Sixty-three patients (98 hips) were randomly divided into two groups. Group A consisted of 28 patients (50 hips) who received cocktail therapy, and group B consisted of 35 patients (48 hips) who received only ESWT. Each affected hip was treated with 6,000 shocks of ESWT at 28 kV (equivalent to 0.62 mJ/mm²) in a single session. Cocktail patients also received HBO therapy performed in a multi-place chamber daily for 20 treatments, and they were administered 70 mg of alendronate orally per week for 1 year. The evaluations included clinical assessment, radiograph and MRI.

Results

After a minimum of 2-years of follow-up, the overall results showed 74% improved, 16% unchanged and 10% worsened in group A; and 79.2% improved, 10.4% unchanged and 10.4% worsened in group B (P = 0.717). Total hip replacement (THR) was performed for 10% of group A and 10.4% of group B (P = 0.946). MRI showed significant reduction in bone marrow edema and a trend of decrease in the size of the lesions in both groups, however, no difference was noted between the two groups. Cocktail therapy is effective for early hip necrosis, but the results are comparable to ESWT in short-term follow up. The joint effects of HBO and alendronate over EWST were not observed.

Conclusion

Long-term results are needed to determine whether or not the synergistic effects of ESWT, HBO and alendronate over ESWT alone exist in early hip necrosis.

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Title: Cocktail therapy for femoral head necrosis of the hip
Authors: Shan-Ling Hsu
Ching-Jen Wang
Mel Shiuann-Sheng Lee
Yi-Sheng Chan
Chung-Cheng Huang
Kuender D. Yang
Publication date: 01-01-2010
Publisher: Springer-Verlag
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 1/2010
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-009-0918-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Cocktail therapy for femoral head necrosis of the hip

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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