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Clinical efficacy of individual extracorporeal shockwave treatment

Klinische Wirksamkeit der individuellen extrakorporalen Stoßwellentherapie

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Abstract

Background

This retrospective study investigated the clinical efficacy of individual extracorporeal shockwave treatment (IESWT) for early stage osteonecrosis of the femoral head (ONFH).

Material and methods

The study included 56 patients (89 hips) with 28 patients (46 hips) in the IESWT group and 28 patients (43 hips) in the conventional ESWT (CESWT) group. The ONFH was caused by the use of steroids, trauma and alcohol consumption. The IESWT focal point was from the front of the femoral head and the exposed necrotic tissue in 3D environment was guided by simulation software. The CESWT focal point was the side of the femoral head and guided by MRI and X‑ray imaging. The evaluation standards included VAS score, Harris hip score (HHS), necrosis volume and healing rate.

Results

For the healing rate the results were 66.67% were improved, 21.43% unimproved and 11.90% aggravated in the CESWT group and 77.78% improved, 17.78% unimproved and 4.45% aggravated in the IESWT group. Statistically significant differences were observed in the healing rate between the two groups (P < 0.05). This retrospective study demonstrated that the healing rate for IEWST was higher than for CEWST. There were no statistically significant differences in the VAS score and the HHS between the two groups (P > 0.05). The effects of pain relief and functional recovery were not obvious and according to our clinical experience this may be due to a short clinical observation time where a longer time might result in better clinical results. Statistically significant differences were observed in the necrosis volume after 18 months between the 2 groups (P < 0.05) and implied that IESWT can significantly reduce the volume of necrosis. The volume after 18 months in the IESWT group was significantly improved compared with baseline (P < 0.05).

Conclusion

The use of IESWT can significantly reduce the necrosis volume. No complications were found.

Zusammenfassung

Hintergrund

Diese retrospektive Studie untersuchte die klinische Wirksamkeit der individuellen extrakorporalen Stoßwellentherapie (IESWT) im Frühstadium einer Osteonekrose des Femurkopfes (ONFH).

Material und Methoden

Die Studie schloss 56 Patienten (89 Hüften) ein, davon waren 28 Patienten (46 Hüften) in der IESWT-Gruppe und 28 Patienten (43 Hüften) in der konventionellen ESWT- bzw. CESWT-Gruppe. Die ONFH wurde durch Steroidanwendung, Traumata und Alkoholkonsum verursacht. Der Fokus der IESWT lag auf der Vorderseite des Femurkopfes, und das exponierte nekrotische Gewebe wurde in 3‑D-Umgebung mittels einer Stimulationssoftware geführt. Der Fokus der CESWT lag auf der Seite des Femurkopfes und wurde mittels MRT und Röngten geführt. Die Evaluationsstandards umfassten den VAS-Score (visuelle Analogskala), den Harris-Hip-Score (HHS), das Nekrosevolumen und die Heilungsrate.

Ergebnisse

In der CESWT-Gruppe zeigten die Ergebnisse für die Heilungsrate in 66,67 % der Fälle eine Verbesserung, in 21,43 % keine Verbesserung und in 11,90 % der Fälle eine Verschlechterung. In der IESWT-Gruppe zeigte sich bei 77,78 % der Patienten eine Verbesserung, bei 17,78 % keine Verbesserung, und bei 4,45 % der Patienten eine Verschlechterung. Bezüglich der Heilungsrate wurden statistisch signifikante Unterschiede zwischen den beiden Gruppen festgestellt (p < 0,05). Diese retrospektive Studie zeigte, dass die Heilungsrate bei IEWST höher war als bei CEWST. Es gab keine statistisch signifikanten Unterschiede im VAS-Score und HHS zwischen den beiden Gruppen (p > 0,05). Auswirkungen auf Schmerzreduktion und funktionelle Besserung waren nicht ersichtlich. Nach der klinischen Erfahrung der Autoren könnte dies an der kurzen klinischen Beobachtungszeit liegen; eine längere Beobachtungszeit könnte möglicherweise zu besseren klinischen Ergebnissen führen. Statistisch signifikante Unterschiede bezüglich des Nekrosevolumens wurden nach 18 Monaten zwischen den beiden Gruppen festgestellt (p < 0,05) und zeigten, dass die IESWT das Nekrosevolumen signifikant reduzieren kann. Das Volumen in der IESWT-Gruppe nach 18 Monaten zeigte eine signifikante Verbesserung im Vergleich zum Ausgangswert (p < 0,05).

Schlussfolgerung

Die Anwendung der IESWT kann das Nekrosevolumen signifikant reduzieren. Komplikationen wurden keine festgestellt.

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Abbreviations

ARCO:

Association Research Circulation Osseous

CESWT:

Conventional extracorporeal shockwave treatment

HHS:

Harris hip score

IESWT:

Individual extracorporeal shockwave treatment

MRI:

Magnetic resonance imaging

ONFH:

Osteonecrosis of the femoral head

VAS:

Visual analogue scale

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Authors and Affiliations

  1. No. 69 Yongding Road, Bei**g, Hai dian District, China

    Hao Ding, Yongming Xu, jun Yan &  Gengyan **ng

  2. Hebei Armed Police Corps hospital, Shijiazhuang hospital, Shijiazhuang, Hebei province, China

    Shuai Wang

  3. Affilliated Hospital Of Hebei Engineering University, Handan, Hebei province, China

    Hu Feng

  4. No. 1, Shanxian County Cultural Road, Heze, China

    xiuna Duan

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  1. Hao Ding
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  7. Gengyan **ng
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Correspondence to Gengyan **ng.

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Conflict of interest

H. Ding, S. Wang, H. Feng, Y. YXu. jun, D. **u na and G. **ng declare that they have no competing interests.

All procedures reported in this article were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

The authors Hao Ding and Shui Wang contributed equally to the manuscript.

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Ding, H., Wang, S., Feng, H. et al. Clinical efficacy of individual extracorporeal shockwave treatment. Orthopäde 48, 610–617 (2019). https://doi.org/10.1007/s00132-018-03682-6

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  • DOI: https://doi.org/10.1007/s00132-018-03682-6

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