Abstract
Osteonecrosis is a progressive clinical condition with significant morbidity, which primarily affects weight-bearing joints and is characterized by the death of the bone, or part of it, because of insufficient circulation. The hip is the most common compromised joint. In osteonecrosis of the femoral head (ONFH), the collapse of the femoral head is a result of mechanically weak bone submitted to a load of weight, and can be associated with incapacitating pain and immobility. Both nonsurgical and surgical treatment options have been used with differing levels of success, and nonoperative treatment modalities such as bisphosphonates, statins, anticoagulants, and extracorporeal shock wave therapy (ESWT) for early-stage disease have been described, but exact indications have not been established yet. The aim of this study was to make a systematic review of the use of ESWT in the treatment of ONFH. MEDLINE, LILACS, and Scielo databases were searched using the keywords “shock wave”, “osteonecrosis”, “avascular necrosis”, “aseptic necrosis” and “femoral head”. The search period was between 1966 and 2009. Only five articles that fulfilled the previously established criteria were obtained. Of these five articles, two were randomized clinical trials, one open label study, one comparative prospective study, and one was a case report. The present review demonstrated that there are no controlled and double-blind studies about the efficacy of ESWT in the treatment of ONFH. On the other hand, the published noncontrolled studies appear to demonstrate some favorable result, which justifies new research in this area.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Marker DR, Seyler TM, McGrath MS, Delanois RE, Ulrich SD, Mont MA (2008) Treatment of early stage osteonecrosis of the femoral head. J Bone Joint Surg Am 90(Suppl 4):175–187
Cardozo J, Andrade D, Santiago M (2008) The use of bisphosphonate in the treatment of avascular necrosis: a systematic review. Clin Rheumatol 27(6):685–688
Mont MA, Lonner JH, Ragland PS (2006) Osteonecrosis of the hip. In: Barrack R, Booth RE Jr, Lonner JH, McCarthy JC, Mont MA, Rubash HE (eds) Orthopaedic knowledge update: hip and knee reconstruction 3, 3rd edn. American Academy of Orthopaedic Surgeons (AAOS), Rosemont (IL), pp 511–519
Malizos KN, Karantanas AH, Varitimidis SE, Dailiana ZH, Bargiotas K, Maris T (2007) Osteonecrosis of the femoral head: etiology, imaging and treatment. Eur J Radiol 63(1):16–28
Massari L, Fini M, Cadossi R, Setti S, Traina GC (2006) Biophysical stimulation with pulsed electromagnetic fields in osteonecrosis of the femoral head. J Bone Joint Surg Am 88(Suppl 3):56–60
Nishii T, Sugano N, Ohzono K, Sakai T, Haraguchi K, Yoshikawa H (2002) Progression and cessation of collapse in osteonecrosis of the femoral head. Clin Orthop Relat Res 400:149–157
Parsons JS, Stelle N (2008) Osteonecrosis of the femoral head: part 2—options for treatment. Current Orthopaedics 22(5):349–358
Ludwig J, Lauber S, Lauber HJ, Dreisilker U, Raedel R, Hotzinger H (2001) High-energy shock wave treatment of femoral head necrosis in adults. Clin Orthop Relat Res 387:119–126
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. J Bone Joint Surg Am 87(11):2380–2387
Wang CJ, Wang FS, Yang KD, Huang CC, Lee MS, Chan YS et al (2008) Treatment of osteonecrosis of the hip: comparison of extracorporeal shockwave with shockwave and alendronate. Arch Orthop Trauma Surg 128(9):901–908
Wang CJ, Wang FS, Ko JY, Huang HY, Chen CJ, Sun YC et al (2008) Extracorporeal shockwave therapy shows regeneration in hip necrosis. Rheumatology (Oxford) 47(4):542–546
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 Arthroplasty 21(6):911–915
Graff J, Pastor J, Stnege T (1987) The effect of high energy shock waves on bony tissue: an experiment study. J Urol 137:278–281
McClure S, Dorfmüller C (2003) Extracorporeal shock wave therapy: theory and equipment. ClinTech Equine Pract 2(4):348–357
Ma HZ, Zeng BF, Li XL (2007) Upregulation of VEGF in subchondral bone of necrotic femoral heads in rabbits with use of extracorporeal shock waves. Calcif Tissue Int 81(2):124–131
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
Hausdorf J, Lutz A, Rohrig H, Maier M (2004) Extracorporeal shock wave therapy and femur head necrosis—pressure measurements in the femur head. Z Orthop Ihre Grenzgeb 142(2):122–126
Acknowledgments
MS is currently receiving a scholarship from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq).
Disclusures
None
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Alves, E.M., Angrisani, A.T. & Santiago, M.B. The use of extracorporeal shock waves in the treatment of osteonecrosis of the femoral head: a systematic review. Clin Rheumatol 28, 1247–1251 (2009). https://doi.org/10.1007/s10067-009-1231-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-009-1231-y