Xu Yang1,2, Lijun Shi3, Tao Zhang4, Fuqiang Gao2, Wei Sun2, Peixu Wang2, Xinjie Wu5, Zirong Li2. 1. Department of Orthopedics, Peking University China-Japan Friendship Clinical Hospital, Beijing, 100029, China. 2. Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Orthopaedic Department, China-Japan Friendship Hospital, Beijing, 100029, China. 3. Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, Henan, China. 4. Department of Chinese Medicine, The First Clinical School of Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China. 5. Department of Molecular Medicine and Surgery, Karolinska Institute, 171 76, Stockholm, Sweden.
Abstract
Background: Studies have shown that high-energy focused extracorporeal shock wave therapy (HF-ESWT) has a certain therapeutic effect on glucocorticoid-induced osteonecrosis of the femoral head (ONFH). This study aimed to observe the efficacy and safety of HF-ESWT as a precautionary measure to reduce the probability of glucocorticoid-induced ONFH. Methods: A prospective randomized controlled trial was designed to evaluate whether HF-ESWT (Group A) can significantly prevent the incidence of glucocorticoid-induced ONFH relative to a control group without shockwave intervention (Group B). MRI was used to assess whether all participants experienced ONFH at 3, 6, and 12 months after the intervention. Continuous scoring was used to evaluate the intervention results: the 10-cm visual analog scale (VAS) was used to evaluate pain, and the hip Harris score (HHS) was used to evaluate the function of the hip joint. Any adverse events were recorded. Results: 153 patients (89 females and 64 males) who had been allocated to group A (75 patients) or Group B (78 patients) were included in the final analysis. The patients were 45.0 ± 13.0 years old. There were significant differences between the two groups in MRI diagnosis of ONFH patients (2 cases in Group A, 9 cases in Group B; p = 0.034). Significant differences between groups were found in bilateral hip function measured using the HHS at 6 months (Left p = 0.026; Right p = 0.033) and 12 months (Left p = 0.018; Right p = 0.038). However, there was no difference in the functional results measured at 3 months and the VAS at any points. Conclusions: This study confirms that HF-ESWT can be successfully used to reduce the probability of glucocorticoid-induced ONFH. Pain and hip dysfunction are common clinical manifestations when ONFH is unavoidable. Therefore, HF-ESWT can be recommended for the prevention and intervention of ONFH high-risk populations receiving high-dose glucocorticoid therapy. The Translational potential of this article: The effective prevention of HF-ESWT on ONFH after high-dose glucocorticoid application demonstrated its transformation potential as a preventive method in the clinical prevention of glucocorticoid-induced ONFH.
Background: Studies have shown that high-energy focused extracorporeal shock wave therapy (HF-ESWT) has a certain therapeutic effect on glucocorticoid-induced osteonecrosis of the femoral head (ONFH). This study aimed to observe the efficacy and safety of HF-ESWT as a precautionary measure to reduce the probability of glucocorticoid-induced ONFH. Methods: A prospective randomized controlled trial was designed to evaluate whether HF-ESWT (Group A) can significantly prevent the incidence of glucocorticoid-induced ONFH relative to a control group without shockwave intervention (Group B). MRI was used to assess whether all participants experienced ONFH at 3, 6, and 12 months after the intervention. Continuous scoring was used to evaluate the intervention results: the 10-cm visual analog scale (VAS) was used to evaluate pain, and the hip Harris score (HHS) was used to evaluate the function of the hip joint. Any adverse events were recorded. Results: 153 patients (89 females and 64 males) who had been allocated to group A (75 patients) or Group B (78 patients) were included in the final analysis. The patients were 45.0 ± 13.0 years old. There were significant differences between the two groups in MRI diagnosis of ONFH patients (2 cases in Group A, 9 cases in Group B; p = 0.034). Significant differences between groups were found in bilateral hip function measured using the HHS at 6 months (Left p = 0.026; Right p = 0.033) and 12 months (Left p = 0.018; Right p = 0.038). However, there was no difference in the functional results measured at 3 months and the VAS at any points. Conclusions: This study confirms that HF-ESWT can be successfully used to reduce the probability of glucocorticoid-induced ONFH. Pain and hip dysfunction are common clinical manifestations when ONFH is unavoidable. Therefore, HF-ESWT can be recommended for the prevention and intervention of ONFH high-risk populations receiving high-dose glucocorticoid therapy. The Translational potential of this article: The effective prevention of HF-ESWT on ONFH after high-dose glucocorticoid application demonstrated its transformation potential as a preventive method in the clinical prevention of glucocorticoid-induced ONFH.
Authors: Nipun Sodhi; Alexander Acuna; Jennifer Etcheson; Nequesha Mohamed; Iciar Davila; Joseph O Ehiorobo; Lynne C Jones; Ronald E Delanois; Michael A Mont Journal: Bone Joint J Date: 2020-07 Impact factor: 5.082
Authors: Quanjun Cui; Woo Lam Jo; Kyung Hoi Koo; Edward Y Cheng; Wolf Drescher; Stuart B Goodman; Yong Chan Ha; Phillippe Hernigou; Lynne C Jones; Shin Yoon Kim; Kyu Sang Lee; Mel S Lee; Yun Jong Lee; Michael A Mont; Nobuhiko Sugano; John Taliaferro; Takuaki Yamamoto; Dewei Zhao Journal: J Korean Med Sci Date: 2021-03-15 Impact factor: 2.153