Xiao Yu1, Difeng Zhang2, Xianjun Chen1, Ji Yang1, Lin Shi1, Qingjiang Pang3. 1. Department of Orthopedics, Ningbo No. 2 Hospital, Zhejiang, 315010, China. 2. Medical School of Ningbo University, Zhejiang, 315211, China. 3. Department of Orthopedics, Ningbo No. 2 Hospital, Zhejiang, 315010, China. Electronic address: pqjey@sina.com.
Abstract
BACKGROUND: Non-traumatic osteonecrosis of the femoral head (ONFH) is a refractory osteonecrosis disease caused by an abnormal blood supply to bone tissue. However, therapeutic hip preservation strategies are diverse, and the therapeutic outcomes are not ideal. OBJECTIVE: A network meta-analysis was performed to assess the effect of hip preservation treatments on non-traumatic ONFH. METHODS: We searched public electronic databases through May 15, 2017 using the following keywords: "femoral head necrosis osteonecrosis"; "femoral head osteonecrosis"; "osteonecrosis of femoral head"; "avascular necrosis of femoral head"; "necrosis of femoral"; and "random*". The primary outcome in the present analysis was the treatment failure rate. Secondary outcomes included the Harris hip and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. RESULTS: We included 21 articles assessing a total of 1415 hips in our analysis. In the network meta-analysis, the treatments were ranked by the surface under the cumulative ranking curve (SUCRA). Core decompression (CD) plus cytotherapy was most likely to reduce the treatment failure rate (SUCRA score = 18.9%), followed by alendronate treatment (SUCRA score = 17.8%), cocktail treatments (SUCRA score = 15.6%), extracorporeal shock wave therapy (ESWT) plus alendronate (SUCRA score = 15.4%), and avascular biomaterials plus cytotherapy (SUCRA score = 13.8%) in a frequentist framework; similar results were obtained in a Bayesian framework. For the secondary outcomes, ESWT was most likely to improve the Harris hip score (SUCRA score = 33.7%), followed by ESWT plus alendronate (SUCRA score = 33.1%) and cocktail (SUCRA score = 19.6%) treatments in a frequentist framework. A traditional analysis showed that the effect of CD plus cytotherapy was significantly better than the effect of CD alone in improving the WOMAC score (SMD, -6.01; 95% CI, -7.81 to -4.22; p < 0.001). CONCLUSION: CD plus cytotherapy is a relatively superior treatment for reducing treatment failure rates in early and intermediate ONFH patients, and ESWT is the most effective treatment for improving Harris hip scores.
BACKGROUND:Non-traumatic osteonecrosis of the femoral head (ONFH) is a refractory osteonecrosis disease caused by an abnormal blood supply to bone tissue. However, therapeutic hip preservation strategies are diverse, and the therapeutic outcomes are not ideal. OBJECTIVE: A network meta-analysis was performed to assess the effect of hip preservation treatments on non-traumatic ONFH. METHODS: We searched public electronic databases through May 15, 2017 using the following keywords: "femoral head necrosis osteonecrosis"; "femoral head osteonecrosis"; "osteonecrosis of femoral head"; "avascular necrosis of femoral head"; "necrosis of femoral"; and "random*". The primary outcome in the present analysis was the treatment failure rate. Secondary outcomes included the Harris hip and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. RESULTS: We included 21 articles assessing a total of 1415 hips in our analysis. In the network meta-analysis, the treatments were ranked by the surface under the cumulative ranking curve (SUCRA). Core decompression (CD) plus cytotherapy was most likely to reduce the treatment failure rate (SUCRA score = 18.9%), followed by alendronate treatment (SUCRA score = 17.8%), cocktail treatments (SUCRA score = 15.6%), extracorporeal shock wave therapy (ESWT) plus alendronate (SUCRA score = 15.4%), and avascular biomaterials plus cytotherapy (SUCRA score = 13.8%) in a frequentist framework; similar results were obtained in a Bayesian framework. For the secondary outcomes, ESWT was most likely to improve the Harris hip score (SUCRA score = 33.7%), followed by ESWT plus alendronate (SUCRA score = 33.1%) and cocktail (SUCRA score = 19.6%) treatments in a frequentist framework. A traditional analysis showed that the effect of CD plus cytotherapy was significantly better than the effect of CD alone in improving the WOMAC score (SMD, -6.01; 95% CI, -7.81 to -4.22; p < 0.001). CONCLUSION:CD plus cytotherapy is a relatively superior treatment for reducing treatment failure rates in early and intermediate ONFH patients, and ESWT is the most effective treatment for improving Harris hip scores.
Authors: Wei Huang; Xuan Gong; Steve Sandiford; Xiaoqiang He; Feilong Li; Yuwan Li; Ziming Liu; Leilei Qin; Jianye Yang; Sizheng Zhu; Jiawei Wang; Xiaolin Tu; Lei Ye; Ning Hu Journal: Ann Transl Med Date: 2019-09
Authors: Phimon Atsawasuwan; Yinghua Chen; Karan Ganjawalla; Albert L Kelling; Carla A Evans Journal: Head Face Med Date: 2018-11-12 Impact factor: 2.151