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 a word, extracorporeal shockwave therapy provides a conservative modality to improve the motor function and relieve the pain of patients with osteonecrosis of femoral head. It possesses advantages such as non-invasiveness, safety, convenience to conduct and economy. Imaging revealed that bone marrow edema was significantly relieved but the necrotic bone or femoral head collapse could not be reversed after ESWT. This technique could slow or even block the progression of ONFH and therefore reduce the demand for surgery. ESWT brings more benefits than core decompression with/without bone grafting for early-stage ONFH and there is no evidence revealing that collaboration with other conservative methods could improve the curative effects of ESWT. Meanwhile, ONFH with various risk factors showed similar reaction to this noninvasive treatment method. Nevertheless, these results should be interpreted carefully due to the low quality of included publications and further studies are requisite to validate the effect of ESWT in ONFH.