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

Whether a synergistic effect of ESWT and other conservative treatments exists was investigated in 2 literatures. In the study published by Wang et al in 2008, they randomly divided 48 patients to 2 groups, receiving ESWT with and without alendronate, respectively. [18] Eventually, the overall clinical outcomes of 2 curative groups were comparable. The differences of pain and functional enhancement between 2 groups were not statistically significant (P = 0.400 and 0.313, respectively). Hsu et al [21] further combined ESWT, alendronate and HBO to treat early ONFH, and this time, a better result of cocktail therapy than ESWT alone was still not testified. Eventually, 10% patients in the cocktail group and 10.4% patients in the ESWT group had to receive THR (P = 0.946).