Hip Pelvis.  2015 Dec;27(4):250-257. 10.5371/hp.2015.27.4.250.

Osteonecrosis of Femoral Head Treated with Extracorporeal Shock Wave Therapy: Analysis of Short-term Clinical Outcomes of Treatment with Radiologic Staging

Affiliations
  • 1Department of Orthopedic Surgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea. oselite@naver.com

Abstract

PURPOSE
To evaluate clinical results of extracorporeal shock wave therapy (ESWT) with radiographic staging on patients with avascular necrosis of femoral head (AVNFH).
MATERIALS AND METHODS
We evaluated 24 patients diagnosed with AVNFH (32 hip joints) who were treated with ESWT from 1993 to 2012. Average follow-up period was 27 months, and the average age of patients was 47.8 years. The Association Research Circulation Osseous (ARCO) system was used to grade radiographic stage prior to treatment. For this study patients were divided into two groups based on their ARCO stage, group 1 (ARCO stages I and II) and group 2 (ARCO stage III). Comparative analyses were done between the two groups using the visual analogue scale (VAS) score and the Harris hip score (HHS) at pre-treatment and 3, 6, 12, and 24 months after treatment. Failure was defined when radiographic stage progressed or arthroplasty surgery was needed due to clinical exacerbation.
RESULTS
Both groups showed clinical improvements with VAS scoring at final follow-up (group 1: median 7 to 1.5, P<0.001; group 2: mean 7 to 4, P=0.056). Using HHS, group 1 showed a significant improvement (from 65.5 to 95 [P<0.001]), while no significance was observed for group 2 (P=0.280). At final follow-up, 3 hips from group 1 and one hip from group 2 showed radiographic improvement; however, two patients underwent total hip arthroplasty due to persistent pain and dysfunction.
CONCLUSION
ESWT can be considered as an interventional option before surgical treatment in patients with not only early stage AVNFH but also with mid stage.

Keyword

Association Research Circulation Osseous; Extracorporeal shock wave therapy; Avascular necrosis of femoral head; Harris hip score

MeSH Terms

Arthroplasty
Arthroplasty, Replacement, Hip
Follow-Up Studies
Head*
Hip
Humans
Necrosis
Osteonecrosis*
Shock*

Figure

  • Fig. 1 Extracorporeal shock wave therapy procedures. (A) Surface marking after the affected hip was positioned in adduction and internal rotation with the limb secured to the table. (B) Targeting to the junctional zone between avascular and vascular bone of the femoral head under C-arm control. (C) Shock waves applied after surgical lubricant was applied to the skin.

  • Fig. 2 Visual analogue scale (VAS) pain scores in extracorporeal shock wave therapy; before and after treatment. Group 1: Association Research Circulation Osseous (ARCO) stage I and II, group 2: ARCO stage III.

  • Fig. 3 Harris hip scores in extracorporeal shock wave therapy: before and after treatment. Group 1: Association Research Circulation Osseous (ARCO) stage I and II, group 2: ARCO stage III.

  • Fig. 4 (A) A 40-year-old male patient showed progressed radiographic stage from Association Research Circulation Osseous (ARCO) stage III-IV at 4 years post extracorporeal shock wave therapy (ESWT). (B) A 50-year-old female patient showed improved radiographic finding from ARCO stage III-II at 2 years post ESWT.


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