Extracorporeal shockwave therapy in osteonecrosis of femoral head: A systematic review of now available clinical evidences

Zhang, Qingyu; Liu, Lihua; Sun, Wei; Gao, Fuqiang; Cheng, Liming; Li, Zirong

In Wang et al's study, [14] 48 ONFH patients with 57 hips were randomized to receive either ESWT or joint-preserving surgery (core decompression and bone-grafting). Participants from 2 groups possessed homogeneous characteristics as well as VAS and Harris hip scores at baseline. At about 2-year follow-up, the ESWT group yielded better outcome in pain relief, Harris scores, hip function in activities of daily living and imaging manifestations. In 2012, Wang et al [25] published a further investigation comparing curative effect of ESWT with core decompression plus autogenous cancellous bone and allogenous fibular graft, and in this study they extended the follow-up to 8-or 9-year. At the last follow-up point, the ratios of good/poor response to treatment were 76/24 and 21/79 in ESWT group and CD group, respectively; meanwhile, THA was applied to 24% and 64% patients in ESWT group and CD group, respectively. Chen and his coworkers included 17 patients with bilateral ONFH, and then treated 17 hips with THA for late disease and other hips with ESWT for early disease. [19] According to the subjective evaluation after treatment, ESWT was valued more highly than THA in 13 patients and believed to be similar to THA in 4 cases. This result indicated that early detection of ONFH was crucial for its management.