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Extracorporal shock wave therapy for the treatment of arthrodesis non-unions

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Abstract

Introduction

Non-union is a regular complication of arthrodeses. Standard treatment includes revision surgery with frequent need for re-revision due to persistent non-union. Particularly patients with concomitant diseases are at risk of secondary complications. There is a need for evaluation of alternative treatment options. The aim of this study is to provide first evidence on union-rate and pain course after focussed extracorporeal shock-wave therapy of arthrodesis non-unions.

Patients and methods

In a retrospective single-centre study, 25 patients with non-union following arthrodesis received one session of focussed extracorporeal shock-wave therapy (energy flux density 0.36 mJ/mm2, 3000 impulses, 23 kV, 4 Hz). Radiographic and clinical results were recorded 6, 12 and 24 weeks after treatment.

Results

24 patients were followed-up. After 24 weeks arthrodeses of the hand healed in 80%, of the upper ankle in 50%, of subtalar joint in 27.2% and of the midfoot in 0% of the cases. Pain decreased from 4.8 (± 2.8) points on the visual analogue scale to 3.4 (± 2.3), 2.9 (± 2.5) and 2.4 (± 2.8) points after 6, 12 and 24 weeks, respectively (p < 0.0001).

Conclusion

Our data indicate that the effect of focussed, high-energy shock wave therapy depends on body region and is effective for the treatment of non-unions of the hand as well as for pain relief.

Level of evidence

Level IV.

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Acknowledgements

We thank PD Dr. Patric Garcia for initiation of structured study and follow-up of patients treated with fESWT. Furthermore, we thank Dr. Britta Wieskötter for the cooperation and advice for patients with non-unions of the hand and Dr. Moritz Freistühler for the calculation of the treatment costs.

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Correspondence to Jens Everding.

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Everding, J., Stolberg-Stolberg, J., Pützler, J. et al. Extracorporal shock wave therapy for the treatment of arthrodesis non-unions. Arch Orthop Trauma Surg (2020). https://doi.org/10.1007/s00402-020-03361-2

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Keywords

  • Shock wave
  • Non-union
  • Arthrodesis
  • Tissue regeneration