Journal of Food, Agriculture and Environment

Evaluation of high energy extracorporeal shock waves in the mid-term and long-term therapy of avascular necrosis of the femoral head 

Author(s):

Songtao Ai ¹, Mengning Yan ^2,3, Liao Wang ^{2, 3}, Meiqiong Qian ¹, Xiaofeng Tao ¹, Xindong Fan ¹*, Kerong Dai ^2,3

Recieved Date: 2013-01-26, Accepted Date: 2013-04-20

Abstract:

This study evaluated the mid- and long-term efficacy of the extracorporeal shock wave therapy (ESWT) in the treatment of femoral head necrosis and observe changes in the necrotic zone. Form October 2004 to January 2011, 46 patients with 82 osteonecrotic femoral head, 12 female (22) and 34 males (60), were enrolled in the trial, including 11 hips at stage I, 32 hips at stage II, 28 hips at stage III and 11 hips at stage IV. ESWT was applied to each patient under spinal anesthesia. The necrosis lesion was localized with C-arm x-ray and/or MRI imaging. Four focal treatment points were selected in each patient. Pain symptom and hip function were evaluated by VAS and Harris score before and after ESWT, respectively. The MRI evaluation about femoral head necrosis was conducted before and after ESWT, including short term (1-12 months), mid term (1-2 years) and long term (3-5 years). Results showed that 3 patients were lost contaction during the trial due to personal reasons. Seventy-nine hips were involved in the final result. Among them, 1 hip underwent total hip arthroplasty in 1.5 years after ESWT due to worsening symptoms. The total follow-up period ranged from 2 months to 5.5 years, with 37 hips in the short-term period, 12 hips in the mid-term period and 30 hips in the long-term periods. Among 45 hips scored with VAS pain score and Harris score, it was reported that in 29 cases hips pain relieved, in 11 cases hips pain was the same and only in 5 cases hips had  increasing pain. The average scores of VAS and Harris score after ESWT were better than those before ESWT. Significant difference was found between the VAS and Harris scores before ESWT. There was no significant difference between the average scores of the VAS in the short- term, mid-term and long-term period (p>0.05, F(VAS) = 1.477). Significant difference was found between the Harris score in short-term and long-term period (p<0.05). During the follow-up period, the MRI images showed that the size of the necrotic zone apparently diminished. Of the II-phase femoral head necrosis 18.9% (15/79) and III-phase femoral head necrosis 13.9% (11/79) were improved after treatment. It can be concluded that the high-energy extracorporeal shock wave therapy appeared to be an effective alternative way to preserve the femoral head in both mid- and long-term follow-ups. 

Keywords:

High-energy extracorporeal shock wave therapy, femoral head necrosis, mid-term and long-term follow-ups, VAS and Harris scores

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Journal: Journal of Food, Agriculture and Environment
Year: 2013
Volume: 11
Issue: 2
Category: Food and Health
Pages: 92-96

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