Skip to main content

Advertisement

SpringerLink
Log in

The use of extracorporeal shock wave therapy (ESWT) in treating osteonecrosis of the femoral head (AVNFH): a retrospective study

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

A Letter to the Editor to this article was published on 11 August 2023

Abstract

Purpose

As most of the cases of avascular necrosis (AVN) in Saudi Arabia is seen in young population and as literature showed good effect of extracorporeal shock wave therapy (ESWT) in reducing pain and oedema in avascular necrosis and delaying the need of surgical intervention. Our purpose of this study is to assess the effectiveness of ESWT in reducing pain, improving range of motion (ROM) and delaying the surgical intervention in patient with AVN of femoral head and compare our results to published literature.

Material and methods

We have treated 24 patients, 13 males and 11 females with a mean age of 29 years (range 14–48) with 34 hips affected. There were 14 unilateral and ten bilateral lesions. In our series 11 out of 24 patients (45.8%) were due to sickle cell disease. Other causes included idiopathic in five patients (20.8%), corticosteroids use and systemic lupus erythematous in three patients each (12.5% each) and post-traumatic AVN in two patients (8.3%). Extracorporeal shock wave therapy was implanted in FICAT stage I, II and III. All patients had two sessions of extracorporeal shock wave therapy, four to six weeks apart, each with 4000 impulses divided into four points. Radiological and MRI assessment were performed at regular time intervals with a minimum follow-up of two years. Clinical assessment was based on Visual Analog Scale and Harris Hip Score (HHS). The end point outcome measurement was the need for any operative intervention.

Results

Operative intervention was necessary in eight out of 34 hips (23.5%), within an average of 2.5 years (range 1 to 5 years). A hip salvage was achieved in 76.5%. Function was improved with the Harris Hip Score from a mean of 54.6 to 80.4 (P value using paired t test ≤ 0.05). Pain assessed with Visual Analog Scale improved from 5.73 to 2.75 (P value using paired t test ≤ 0.05).

Conclusion

We do recommend the use of ESWT in treating AVN of bone whether of femoral head or other sites prior to the collapse of the articular surface. Further studies are needed to compare using two or more sessions as well as using four or six points for ESWT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Mankin HJ (1992) Nontraumatic necrosis of bone (osteonecrosis). N Engl J Med 326(22):1473–1479

    Article  CAS  PubMed  Google Scholar 

  2. Petek D, Hannouche D, Suva D (2019) Osteonecrosis of the femoral head: pathophysiology and current concepts of treatment. EFORT Open Rev 4(3):85

    Article  PubMed  PubMed Central  Google Scholar 

  3. Dudkiewicz I, Covo A, Salai M, Israeli A, Amit Y, Chechik A (2004) Total hip arthroplasty after avascular necrosis of the femoral head: does etiology affect the results? Arch Orthop Trauma Surg 124:82–85

    Article  PubMed  Google Scholar 

  4. Chen JM, Hsu SL, Wong T, Chou WY, Wang CJ, Wang FS (2009) Functional outcomes of bilateral hip necrosis: total hip arthroplasty versus extracorporeal shockwave. Arch Orthop Trauma Surg 129:837–841

    Article  PubMed  Google Scholar 

  5. Rp F (1985) Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg (Br) 67(1):3–9

    Google Scholar 

  6. Gardniers JW (1993) ARCO committee on terminology and staging (report on the committee meeting at Santiago de Compostela). ARCO Newsletter 5:79–82

    Google Scholar 

  7. Steinberg ME, Hayken GD, Steinberg DR (1995) A quantitative system for staging avascular necrosis. J Bone Joint Surg Br 77(1):34–41

    Article  CAS  PubMed  Google Scholar 

  8. Kim SY, Kim YG, Kim PT, Ihn JC, Cho BC, Koo KH (2005) Vascularized compared with nonvascularized fibular grafts for large osteonecrotic lesions of the femoral head. JBJS 87(9):2012–2018

    Article  Google Scholar 

  9. Wang CJ, Huang CC, Wang JW, Wong T, Yang YJ (2012) Long-term results of extracorporeal shockwave therapy and core decompression in osteonecrosis of the femoral head with eight-to nine-year follow-up. Biom J 35(6):481–485

    Google Scholar 

  10. Wang CJ, Wang FS, Yang KD, Huang CC, Lee MSS, Chan YS et al (2008) Treatment of osteonecrosis of the hip: comparison of extracorporeal shockwave with shockwave and alendronate. Arch Orthop Trauma Surg 128:901–908

    Article  CAS  PubMed  Google Scholar 

  11. Hsu SL, Wang CJ, Lee MSS, Chan YS, Huang CC, Yang KD (2010) Cocktail therapy for femoral head necrosis of the hip. Arch Orthop Trauma Surg 130:23–29

    Article  PubMed  Google Scholar 

  12. Wang CJ, Wang FS, Huang CC, Yang KD, Weng LH, Huang HY (2005) Treatment for osteonecrosis of the femoral head: comparison of extracorporeal shock waves with core decompression and bone-grafting. JBJS 87(11):2380–2387

    Google Scholar 

  13. Lin PC, Wang CJ, Yang KD, Wang FS, Ko JY, Huang CC (2006) Extracorporeal shockwave treatment of osteonecrosis of the femoral head in systemic lupus erythematosis. J Arthroplast 21(6):911–915

    Article  Google Scholar 

  14. Alkhawashki HM (2015) Shock wave therapy of fracture nonunion. Injury 46(11):2248–2252

    Article  PubMed  Google Scholar 

  15. Ogden JA, Tóth-Kischkat A, Schultheiss R (2001) Principles of shock wave therapy. Clin Orthop Relat Res 1976-2007(387):8–17

    Article  Google Scholar 

  16. Wang CJ (2012) Extracorporeal shockwave therapy in musculoskeletal disorders. J Orthop Surg Res 7(1):1–8

    Article  Google Scholar 

  17. Alves EM, Angrisani AT, Santiago MB (2009) The use of extracorporeal shock waves in the treatment of osteonecrosis of the femoral head: a systematic review. Clin Rheumatol 28:1247–1251

    Article  PubMed  Google Scholar 

  18. Cabanela M (1976-2007) E. (1990). Bipolar versus total hip arthroplasty for avascular necrosis of the femoral head. A comparison. Clin Orthop Relat Res 261:59–62

    Google Scholar 

  19. Wang CJ, Ko JY, Chan YS, Lee MS, Chen JM, Wang FS et al (2009) Extracorporeal shockwave for hip necrosis in systemic lupus erythematosus. Lupus 18(12):1082–1086

    Article  CAS  PubMed  Google Scholar 

  20. Wang CJ, Wang FS, Ko JY, Huang HY, Chen CJ, Sun YC, Yang YJ (2008) Extracorporeal shockwave therapy shows regeneration in hip necrosis. Rheumatology 47(4):542–546

    Article  PubMed  Google Scholar 

  21. Ma HZ, Zeng BF, Li XL, Chai YM (2008) Temporal and spatial expression of BMP-2 in sub-chondral bone of necrotic femoral heads in rabbits by use of extracorporeal shock waves. Acta Orthop 79(1):98–105

    Article  PubMed  Google Scholar 

  22. Yin TC, Wang CJ, Yang KD, Wang FS, Sun YC (2011) Shockwaves enhance the osteogenetic gene expression in marrow stromal cells from hips with osteonecrosis. Chang Gung Med J 34(4):367–374

    PubMed  Google Scholar 

  23. Russo S, Lanza F, Passaretti U, Corrado EM (1996) Diagnosis and early treatment of aseptic bone necrosis with high energy shock waves: preliminary notes. J Hand Surg 21(1_suppl):15–15

    Article  Google Scholar 

  24. Gao F, Sun W, Li Z, Guo W, Wang W, Cheng L, Wang B (2015) High-energy extracorporeal shock wave for early stage osteonecrosis of the femoral head: a single-center case series. Evid-based Complement Altern Med 2015:8. https://doi.org/10.1155/2015/468090

    Article  Google Scholar 

  25. Kong FR, Liang YJ, Qin SG, Li JJ, Li XL (2010) Clinical application of extracorporeal shock wave to repair and reconstruct osseous tissue framework in the treatment of avascular necrosis of the femoral head (ANFH). Zhongguo gu Shang= China. J Orthop Traumatol 23(1):12–15

    Google Scholar 

  26. Zhang Q, Liu L, Sun W, Gao F, Cheng L, Li Z (2017) Extracorporeal shockwave therapy in osteonecrosis of femoral head: a systematic review of now available clinical evidences. Medicine 96(4)

  27. Wang CJ, Cheng JH, Huang CC, Yip HK, Russo S (2015) Extracorporeal shockwave therapy for avascular necrosis of femoral head. Int J Surg 24:184–187

    Article  PubMed  Google Scholar 

  28. Hernigou P, Verrier S, Homma Y, Rouard H, Lachaniette CHF, Sunil Kumar KH (2023) Prognosis of hip osteonecrosis after cell therapy with a calculator and artificial intelligence: ten year collapse-free survival prediction on three thousand and twenty one hips. Int Orthop 47(7):1689–1705

    Article  PubMed  Google Scholar 

  29. Hong Z, Zhang Y, Chen J, Bi Q (2023) Adipose-derived stromal vascular fraction injection following core decompression and biochemistry artificial bone graft implantation in osteonecrosis of the femoral head. Int Orthop 47(6):1481–1486

    Article  PubMed  Google Scholar 

  30. Osawa Y, Takegami Y, Kato D, Okamoto M, Iida H, Imagama S (2023) Hip function in patients undergoing conservative treatment for osteonecrosis of the femoral head. Int Orthop 47(1):89–94

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Advanced Medical Center, Riyadh, Saudi Arabia

    Hazem M. Alkhawashki

  2. Department of Radiology and Medical Imaging, College of Medicine, King Saud University, Riyadh, Saudi Arabia

    Ahmad A. Al-Boukai

  3. Department of Orthopaedic Surgery, College of Medicine, Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia

    Mohammed S. Al-Harbi

  4. Department of Orthopaedic Surgery, Prince Sultan Military Medical City, Armed Forces Medical Services, Ministry of Defense, P.O. Box: 7897, Riyadh, 11159, Saudi Arabia

    Mohammed H. Al-Rumaih

  5. Neuroinformatic, School of Computing, Newcastle University, Newcastle upon Tyne, UK

    Mohammad H. Al-Khawashki

Authors
  1. Hazem M. Alkhawashki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ahmad A. Al-Boukai
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mohammed S. Al-Harbi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohammed H. Al-Rumaih
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mohammad H. Al-Khawashki
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors are equally conceived and designed the study, conducted the research, provided the research materials, and collected, organized, analyzed and interpreted data. All authors have critically reviewed and approved the final draft and are responsible for the content .

Corresponding authors

Correspondence to Hazem M. Alkhawashki or Mohammed H. Al-Rumaih.

Ethics declarations

Ethical approval and consent to participate

An Institutional Review Board (IRB) approval was obtained from the primary institute. Written informed consent was obtained from the patients for publication. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request. The authors certify that all appropriate patient consent forms were obtained. The patients understand that their names and initials will not be published, and all efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Alkhawashki, H.M., Al-Boukai, A.A., Al-Harbi, M.S. et al. The use of extracorporeal shock wave therapy (ESWT) in treating osteonecrosis of the femoral head (AVNFH): a retrospective study. International Orthopaedics (SICOT) 47, 2953–2960 (2023). https://doi.org/10.1007/s00264-023-05904-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-023-05904-9

Keywords

Search

Navigation