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

As for the study design, 2 [15, 28] were case reports, 9 [13, 14, 16, [22] [23] [24] [25] 27, 29] were open label trials, 2 [20, 26] were cohorts, and 4 [17] [18] [19] 24] were randomized controlled trials (RCTs). Twelve [13, 14, [16] [17] [18] [19] [20] [21] [23] [24] [25] 27] studies were prospective ones and 5 [15, 22, 26, 28, 29] were retrospective ones. All patients were diagnosed with ONFH. Fourteen [14] [15] [16] [17] [18] [19] [20] [21] [22] [23] [24] [25] [26] [27] articles provided the energy intensity of ESWT, all of which exceeded 0.18 mj/mm 2 and 9 were 0.62 mj/mm 2 . The patient population of these studies ranged from 1 to 335. Eleven [13, 15, 16, 20, [22] [23] [24] [26] [27] [28] [29] studies only investigated the effect of extracorporeal shockwave, 4 [14, 17, 19, 25] compared the performance of ESWT with operations (jointpreserving surgeries or endoprosthetic replacement of joint) and 2 [18, 21] compared the effect of ESWT with cocktail therapy (ESWT combined with other noninvasive modalities). Sixteen [13] [14] [15] [16] [18] [19] [20] [21] [22] [23] [24] [25] [26] [27] [28] [29] studies presented the visual analog scale (VAS) and/or Harris hip score before and after the treatment as evaluation indicators. Other outcome assessment indexes provided by these literatures included the Western Ontario and McMaster Universities Arthritis Index (WOMAC), the 12item Short Form (SF-12) Survey, magnetic resonance imaging manifestation, the need for surgical intervention as well as numbers of patients with improved, stable and deteriorating conditions.