Dosage effects of extracorporeal shockwave therapy in early hip necrosis

Ching-Jen Wang; Chung-Cheng Huang; Hon-Kan Yip; Ya-Ju Yang

doi:10.1016/j.ijsu.2016.09.013

Dosage effects of extracorporeal shockwave therapy in early hip necrosis

Int J Surg. 2016 Nov:35:179-186. doi: 10.1016/j.ijsu.2016.09.013. Epub 2016 Sep 21.

Authors

Ching-Jen Wang¹, Chung-Cheng Huang², Hon-Kan Yip³, Ya-Ju Yang⁴

Affiliations

¹ Center for Shockwave Medicine and Tissue Engineering, Department of Medical Research, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan; Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan.
² Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan. Electronic address: cch2269@gmail.com.
³ Center for Shockwave Medicine and Tissue Engineering, Department of Medical Research, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan; Department of Cardiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan.
⁴ Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan.

PMID: 27664561
DOI: 10.1016/j.ijsu.2016.09.013

Abstract

Background: This study investigated the effects of different dosages of extracorporeal shockwave therapy (ESWT) in early osteonecrosis of the femoral head (ONFH).

Materials and methods: Thirty-three patients (42 hips) were randomly divided into three groups. Group A (10 patients with 16 hips) received 2000 impulses of ESWT at 24 Kv to the affected hip. Group B (11 patients with 14 hips) and Group C (12 patients with 12 hips) received 4000 and 6000 impulses of ESWT respectively. The evaluations included clinical assessment, radiographs, dynamic contrast-enhanced MRI for microcirculation (K^trans) and plasma volume (Vp), and blood tests for biomarker analysis (NO3, VEGF, BMP-2, osteocalcin, TNF-α, IL-6, substance P, CGRP, DKK-1 and IGF).

Results: Significant differences of pain and Harris hip scores were noticed between Group A and C in 6 months after ESWT (all P < 0.05). The pain score decreased, but not Harris hip score improved over the observation time period from 6 to 24 months. Total hip arthroplasty was performed in 3 patients (4 hips) in Group A, but none in Groups B and C. Group C showed significant changes in serum biomarkers for angiogenesis, osteogenesis, anti-inflammation, pain threshold and tissue regeneration between one week and one month after treatment (all P < 0.05). However, no significant changes in the infarction volume in image studies were noted in all groups (all P > 0.05). The post-treatment K^trans and Vp in the peri-necrotic areas of Group B and C were significantly greater than pre-treatment data (both P < 0.05).

Conclusions: High dosage ESWT is more effective in early stage ONFH. The systemic beneficial effects of ESWT may ultimately enhance angiogenesis with improvement of microcirculation of the peri-necrotic areas, that in turn, can improve subchondral bone remodeling and prevent femoral head collapse.

Keywords: Angiogenesis; Anti-inflammation; ESWT dosage; Hip necrosis; Osteogenesis; Pain threshold; Tissue regeneration.

Publication types

Randomized Controlled Trial

MeSH terms

Adolescent
Adult
Angiogenesis Inducing Agents / radiation effects
Arthralgia / etiology
Arthralgia / therapy
Arthroplasty, Replacement, Hip
Biomarkers / blood
Bone Regeneration / radiation effects
Bone Remodeling / radiation effects*
Female
Femur Head Necrosis / blood
Femur Head Necrosis / complications
Femur Head Necrosis / physiopathology
Femur Head Necrosis / therapy*
High-Energy Shock Waves / therapeutic use*
Humans
Inflammation / etiology
Inflammation / therapy
Male
Middle Aged
Osteogenesis / radiation effects
Radiation Dosage
Young Adult

Substances

Angiogenesis Inducing Agents
Biomarkers