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Journal of Orthopaedic Surgery and Research

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Open Access 01-12-2018 | Research article

Meta-analysis of the potential role of extracorporeal shockwave therapy in osteonecrosis of the femoral head

Authors: Yangquan Hao, Hao Guo, Zhaochen Xu, Handeng Qi, Yugui Wang, Chao Lu, Jie Liu, Puwei Yuan

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2018

Abstract

Background

We aimed to evaluate the role of extracorporeal shockwave therapy (ESWT) in improving osteonecrosis of the femoral head (ONFH).

Methods

We 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.

Results

Four 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).

Conclusion

For patients at an early stage, ESWT may be safe and effective for relief of pain and improvement of motor function.

Nakai T, Masuhara K, Nakase T, Sugano N, Ohzono K, Ochi T. Pathology of femoral head collapse following transtrochanteric rotational osteotomy for osteonecrosis. Arch Orthop Trauma Surg. 2000;120(9):489–92.CrossRefPubMed

Leclerc C, Néant I, Moreau M. The calcium: an early signal that initiates the formation of the nervous system during embryogenesis. Jorgchem. 2012;36(18):2720–1.

Pascart T, Falgayrac G, Migaud H, Quinchon JF, Norberciak L, Budzik JF, et al. Region specific Raman spectroscopy analysis of the femoral head reveals that trabecular bone is unlikely to contribute to non-traumatic osteonecrosis. Sci Rep. 2017;7(1):017–00162.CrossRef

Zhao DW, Yu M, Hu K, Wang W, Yang L, Wang BJ, et al. Prevalence of nontraumatic osteonecrosis of the femoral head and its associated risk factors in the Chinese population: results from a nationally representative survey. Chin Med J. 2015;128(21):2843–50.CrossRefPubMedPubMedCentral

Kang JS, Park S, Song JH, Jung YY, Cho MR, Rhyu KH. Prevalence of osteonecrosis of the femoral head: a nationwide epidemiologic analysis in Korea. J Arthroplasty. 2009;24(8):1178–83.CrossRefPubMed

Qiang H, Liu H, Ling M, Wang K, Zhang C. Early steroid-induced osteonecrosis of rabbit femoral head and Panax notoginseng saponins: mechanism and protective effects. Evid Based Complement Alternat Med. 2015;2015:719370. https://doi.org/10.1155/2015/719370. CrossRefPubMedPubMedCentral

Sadile F, Bernasconi A, Russo S, Maffulli N. Core decompression versus other joint preserving treatments for osteonecrosis of the femoral head: a meta-analysis. Br Med Bull. 2016;118(1):33–49.CrossRefPubMedPubMedCentral

Kuroda Y, Matsuda S, Akiyama H. Joint-preserving regenerative therapy for patients with early-stage osteonecrosis of the femoral head. Inflamm Regen. 2016;36(4):016–0002.

Lin PC, Wang CJ, Yang KD, Wang FS, Ko JY, Huang CC. Extracorporeal shockwave treatment of osteonecrosis of the femoral head in systemic lupus erythematosis. J Arthroplast. 2006;21(6):911–5.CrossRef

10.

Wang CJ, Huang CC, Wang JW, Wong T, Yang YJ. Long-term results of extracorporeal shockwave therapy and core decompression in osteonecrosis of the femoral head with eight- to nine-year follow-up. Biom J. 2012;35(6):481–5.

11.

Zhang Q, Liu L, Sun W, Gao F, Cheng L, Li Z. Extracorporeal shockwave therapy in osteonecrosis of femoral head: a systematic review of now available clinical evidences. Medicine. 2017;96(4):e5897.CrossRefPubMedPubMedCentral

12.

Chen JMHS, Wong T, Chou WY, Wang CJ, Wang FS. Functional outcomes of bilateral hip necrosis: total hip arthroplasty versus extracorporeal shockwave. Arch Orthop Trauma Surg. 2009;129:837–41.CrossRefPubMed

13.

Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0: The Cochrane Collaboration; 2011. Available from http://handbook.cochrane.org.

14.

Feng R-N, Zhao C, Sun C-H, Li Y. Meta-analysis of TNF 308 G/A polymorphism and type 2 diabetes mellitus. PLoS One. 2011;6(4):e18480.CrossRefPubMedPubMedCentral

15.

Lei ZGX, Chuan J, Bing L, Zhe Z, Xuming W. Therapeutic effects of extracorporeal shock waves combined with drilling decompression for the treatment of femoral head ischemic necrosis due to training in servicemen. Med J Chin PLA. 2008;33:348–50.

16.

Neumayr LD, Aguilar C, Earles AN, Jergesen HE, Haberkern CM, Kammen BF, et al. Physical therapy alone compared with core decompression and physical therapy for femoral head osteonecrosis in sickle cell disease. Results of a multicenter study at a mean of three years after treatment. J Bone Joint Surg Am. 2006;88(12):2573–82.CrossRefPubMed

17.

Wang CJ, Wang FS, Huang CC, Yang KD, Weng LH, Huang HY. Treatment for osteonecrosis of the femoral head: comparison of extracorporeal shock waves with core decompression and bone-grafting. J Bone Joint Surg Am. 2005;87(11):2380–7.PubMed

18.

Raza A, Harwood A, Totty J, Smith G, Chetter I. Extracorporeal shockwave therapy for peripheral arterial disease: a review of the potential mechanisms of action. Ann Vasc Surg. 2017;45:294–8.CrossRefPubMed

19.

Korakakis V, Whiteley R, Tzavara A, Malliaropoulos N. The effectiveness of extracorporeal shockwave therapy in common lower limb conditions: a systematic review including quantification of patient-rated pain reduction. Br J Sports Med. 2018;52(6):387–407.PubMed

20.

Hongjun ZSW, Kejie F, Shaohui W, Yanzhao Z. Extracorporeal shock wave therapy combined with autologous bone marrow stem cells transplantation for treating early-stage osteonecrosis of the femoral head. Chin J Phys Med Rehabil. 2015;37:287–90.

21.

Alvarenga JC, Fuller H, Pasoto SG, Pereira RM. Age-related reference curves of volumetric bone density, structure, and biomechanical parameters adjusted for weight and height in a population of healthy women: an HR-pQCT study. Osteoporos Int. 2017;28(4):1335–46.CrossRefPubMed

22.

Zura R, Braid-Forbes MJ, Jeray K, Mehta S, Einhorn TA, Watson JT, et al. Bone fracture nonunion rate decreases with increasing age: a prospective inception cohort study. Bone. 2017;95:26–32.CrossRefPubMed

23.

IntHout J, Ioannidis JP, Borm GF, Goeman JJ. Small studies are more heterogeneous than large ones: a meta-meta-analysis. J Clin Epidemiol. 2015;68(8):860–9.CrossRefPubMed

Title: Meta-analysis of the potential role of extracorporeal shockwave therapy in osteonecrosis of the femoral head
Authors: Yangquan Hao
Hao Guo
Zhaochen Xu
Handeng Qi
Yugui Wang
Chao Lu
Jie Liu
Puwei Yuan
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2018
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-018-0861-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Meta-analysis of the potential role of extracorporeal shockwave therapy in osteonecrosis of the femoral head

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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