Clinical and Radiological Outcomes of Extracorporeal Shock Wave Therapy in Early-Stage Femoral Head Osteonecrosis

Abstract EN

Objective.

Femoral head osteonecrosis is a progressive clinical condition with significant morbidity and long-term disability.

Several treatment modalities including both surgical and nonsurgical options have been used with variable levels of success.

High-energy extracorporeal shock wave therapy is a nonoperative treatment option that has been described for early-stage disease.

We aimed to assess the functional and radiological outcomes of extracorporeal shockwave therapy (ESWT) in the treatment of osteonecrosis of the femoral head (ONFH).

Methods.

Thirty-three hips of 21 patients were included in this study.

Adult patients with ONFH of any etiology and in the precollapse stage were included.

Clinical (visual analogue scale [VAS] and Harris hip score [HHS]) and radiological (plain radiographs and magnetic resonance imaging [MRI]) evaluations were performed before and after intervention.

We used 3000–4500 pulses in a single session performed under general anesthesia.

Results.

At an average of 8 months after ESWT, pain scores and HHS were significantly improved compared with the preintervention scores (p<0.001).

The overall clinical outcomes were improved in 21 hips (63.3%), unchanged in 5 hips (15.15%), and worsened in 7 hips (21.2%).

A trend toward a decrease in the size of the ONFH was observed although not of clinical significance (p=0.235).

MRI revealed significant resolution of bone marrow edema (p<0.003).

Regression was observed in 9 lesions (42.9%) and progression in 1 lesion (4.7%); no change was observed in the remaining 23 lesions (52.4%).

Conclusion.

ESWT is a viable noninvasive treatment option for early-stage ONFH.

It significantly improves clinical outcomes and may halt or delay the radiographic progression of the disease in the precollapse stage.