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

There were several limitations existing in our research. First, the evidence quality of our included studies was various. Only 4 studies were classified as Ib evidence according to Oxford Centre for EBM Levels of Evidence. Second, this is a systematic review and we could only discuss issues based on existing clinical evidences. Third, due to limited number of studies, quantitative analysis (meta-analysis) of extracted data is impossible. Finally, populations of most included studies were very small. This SR also reminds us of several research directions in the future. Persisting histopathological or even genetic experiments are indispensable to further clarify the mechanism of ESWT in the treatment of ONFH. Meanwhile, charging voltage, energy intensity, focus size, number of session and impulse of extracorporeal shockwave adopted by included studies were heterogeneous; therefore, a standardized therapeutic schedule of ESWT for ONFH needs to be determined. Last but not least, it is urgent for clinicians to discover other effective conservative modalities which could be applied to ONFH alone or enhance the benefits of ESWT.