A 12-year follow-up study of combined treatment of post-severe acute respiratory syndrome patients with femoral head necrosis

Liu, Tiansheng; Ma, Jinchao; Su, Bin; Wang, Hao; Wang, Qi; Ma, Xinlong

Currently, major conservation treatments include drugs, hyperbaric oxygen, extracorporeal shock, pulsed electromagnetic treatment, decreased loading, and proper breaking and retraction. [8] [9] [10] This study performed combined treatment including alendronate sodium, extracorporeal shock and hyperbaric oxygen on all included patients, followed by 12-year post-op follow-ups. Alendronate drugs can inhibit bone absorption ability of osteoclasts, accelerate osteoclast apoptosis, improve bone volume and bone strength, and facilitate bone healing, thus impeding and retarding ONFH progression, decreasing bone absorption and femoral head collapse, as well as decreasing the frequency of surgery for collapse. Hong et al showed that alendronate is one effective 13 However, due to potential side effects including jaw bone necrosis or bone fracture after long-term application of alendronate, some surgeons still prefer surgery approaches. 13 Bone et al observed 10-year study on menopausal women and found no significant correlation between alendronate drugs and bone fracture. 14 This study performed 12-year alendronate sodium treatment (70 mg weekly) on all post-SARS ONFH patients and found no jaw bone absorption or fracture among all patients. Extracorporeal shock wave therapy (ESWT) can alleviate or treat ONFH via enhancing expression of vascular endothelial growth factor (VEGF) in subchondral bones of the femoral head and induction of de novo angiogenesis to improve femoral head blood supply. Vulpiani et al found that ESWT could benefit bone reconstruction and regeneration via stimulating vascular growth factor expression. 15 , 16 Wang et al compared ESWT and surgery approach and found that ESWT had significant clinical efficacy and less probability of surgery. 17 Lin et al also showed efficacy of ESWT on prednisone treatmentinduced ONFH after systemic lupus erythematosus (SLE) treatment. 18 20 Hyperbaric oxygen environment can enhance oxygen concentration in blood, thus alleviating oxygen perfusion into bone tissues for reducing