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Mei J, Pang L, Jiang Z. The effect of extracorporeal shock wave on osteonecrosis of femoral head: a systematic review and meta-analysis. PHYSICIAN SPORTSMED 2022; 50:280-288. [PMID: 34058957 DOI: 10.1080/00913847.2021.1936685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION This study aims to determine whether ESWT (extracorporeal shock wave therapy) affects ONFH (osteonecrosis of femoral head) in clinical outcomes and radiography outcomes. METHOD Two authors independently search the papers on the treatment of femoral head necrosis with extracorporeal shock wave in CNKI (China National Knowledge Infrastructure), VIP (China Science and Technology Journal Database), CSPD (China Science Periodical Database), Pubmed, Embase, and Springer databases. Search period from the inception dates to 2 June 2020 and have no limitations in language; two authors independently conducted a quality evaluation and data extraction for included studies and performed a meta-analysis with data extracted and calculate by using RevMan5. Registration number: CRD42020213580. RESULT Nine articles with 409 patients are included in this meta-analysis. The pooled results of HHS (Harris hip score) in eight studies with 337 hips show that ESWT achieves higher Harris scores compared to before treatment (MD = -19.95; 95% CI: -26.27, -13.64) and the difference is statistically significant (p < 0.01). The pooled results of VAS (visual analogue score) in seven studies with 253 hips show that ESWT achieves lower VAS compared to baseline (MD = 2.77; 95% CI: 1.88, 3.65) and the difference is statistically significant (p < 0.01). The pooled results of lesion of MRI with 164 hips show that ESWT decreases the lesion area of MRI (SMD = 1.03; CI: 0.75,1.30) and the difference is statistically significant (p < 0.01). CONCLUSION ESWT has an effect on pain relief and has a limited effect on motion function. Its effect may be better than surgical groups (core decompression and core decompression with bone grafting). But it cannot decrease the lesion area of the femoral head on MRI and stop disease progression.
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Affiliation(s)
- Jin Mei
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Lili Pang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhongchao Jiang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Konarski W, Poboży T, Śliwczyński A, Kotela I, Krakowiak J, Hordowicz M, Kotela A. Avascular Necrosis of Femoral Head-Overview and Current State of the Art. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127348. [PMID: 35742595 PMCID: PMC9223442 DOI: 10.3390/ijerph19127348] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 12/04/2022]
Abstract
Avascular necrosis (AVN) of the femoral head is caused by disruption of the blood supply to the proximal femur. The alterations in the blood supply may occur following a traumatic event or result from a non-traumatic cause. Femoral neck fracture and hip dislocation and associated surgical procedures, corticosteroid therapy, and alcohol abuse frequently lead to AVN development. Type of fracture (displaced or undisplaced) and time between injury and surgery are the most critical factors in assessing the risk of developing AVN. Diagnosis of AVN can be established based on patients’ complaints, medical history, and radiographic findings. There is no consensus on the treatment of patients with AVN to date. Non-surgical methods are dedicated to patients in the early pre-collapse stages of the disease and consist of pharmacotherapy and physiotherapy. Surgery is recommended for patients with advanced disease.
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Affiliation(s)
- Wojciech Konarski
- Department of Orthopaedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland;
- Correspondence: ; Tel.: +48-(50)-2110863
| | - Tomasz Poboży
- Department of Orthopaedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland;
| | - Andrzej Śliwczyński
- Department of Social and Preventive Medicine, Social Medicine Institute, Medical University of Lodz, 90-647 Lodz, Poland; (A.Ś.); (J.K.)
| | - Ireneusz Kotela
- Department of Orthopedic Surgery and Traumatology, Central Research Hospital of Ministry of Interior, Wołoska 137, 02-507 Warsaw, Poland;
| | - Jan Krakowiak
- Department of Social and Preventive Medicine, Social Medicine Institute, Medical University of Lodz, 90-647 Lodz, Poland; (A.Ś.); (J.K.)
| | - Martyna Hordowicz
- General Psychiatry Unit III, Dr Barbara Borzym’s Independent Public Regional Psychiatric Health Care Center, 26-600 Radom, Poland;
| | - Andrzej Kotela
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, Woycickiego 1/3, 01-938 Warsaw, Poland;
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Liu N, Zheng C, Wang Q, Huang Z. Treatment of non‑traumatic avascular necrosis of the femoral head (Review). Exp Ther Med 2022; 23:321. [PMID: 35386618 PMCID: PMC8972838 DOI: 10.3892/etm.2022.11250] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/26/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ning Liu
- Department of Orthopedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | | | - Qinglong Wang
- Department of Orthopedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Zhipeng Huang
- Department of Orthopedics, The Second Affiliated Hospital of Air Force Military Medical University, Xi'an, Shaanxi 710000, P.R. China
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Abstract
Osteonecrosis of the femoral head is a disabling pathology affecting a young population (average age at treatment, 33 to 38 years) and is the most important cause of total hip arthroplasty in this population. It reflects the endpoint of various disease processes that result in a decrease of the femoral head blood flow.The physiopathology reflects an alteration of the vascularization of the fine blood vessels irrigating the anterior and superior part of the femoral head. This zone of necrosis is the source of the loss of joint congruence that leads to premature wear of the hip.Several different types of medication have been developed to reverse the process of ischemia and/or restore the vascularization of the femoral head. There is no consensus yet on a particular treatment.The surgical treatments aim to preserve the joint as far as the diagnosis could be made before the appearance of a zone of necrosis and the loss of joint congruence. They consist of bone marrow decompressions, osteotomies around the hip, vascular or non-vascular grafts.Future therapies include the use of biologically active molecules as well as implants impregnated with biologically active tissue. Cite this article: EFORT Open Rev 2019;4:85-97. DOI: 10.1302/2058-5241.4.180036.
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Affiliation(s)
- Daniel Petek
- Clinic of Orthopaedics and Trauma Surgery, HFR-Fribourg District Hospitals, Fribourg, Switzerland
| | - Didier Hannouche
- Clinic of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Domizio Suva
- Clinic of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland
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Clinical and Radiological Outcomes of Extracorporeal Shock Wave Therapy in Early-Stage Femoral Head Osteonecrosis. Adv Orthop 2018; 2018:7410246. [PMID: 30210874 PMCID: PMC6120295 DOI: 10.1155/2018/7410246] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 07/19/2018] [Accepted: 07/31/2018] [Indexed: 12/13/2022] Open
Abstract
Objective Femoral head osteonecrosis is a progressive clinical condition with significant morbidity and long-term disability. Several treatment modalities including both surgical and nonsurgical options have been used with variable levels of success. High-energy extracorporeal shock wave therapy is a nonoperative treatment option that has been described for early-stage disease. We aimed to assess the functional and radiological outcomes of extracorporeal shockwave therapy (ESWT) in the treatment of osteonecrosis of the femoral head (ONFH). Methods Thirty-three hips of 21 patients were included in this study. Adult patients with ONFH of any etiology and in the precollapse stage were included. Clinical (visual analogue scale [VAS] and Harris hip score [HHS]) and radiological (plain radiographs and magnetic resonance imaging [MRI]) evaluations were performed before and after intervention. We used 3000–4500 pulses in a single session performed under general anesthesia. Results At an average of 8 months after ESWT, pain scores and HHS were significantly improved compared with the preintervention scores (p<0.001). The overall clinical outcomes were improved in 21 hips (63.3%), unchanged in 5 hips (15.15%), and worsened in 7 hips (21.2%). A trend toward a decrease in the size of the ONFH was observed although not of clinical significance (p=0.235). MRI revealed significant resolution of bone marrow edema (p<0.003). Regression was observed in 9 lesions (42.9%) and progression in 1 lesion (4.7%); no change was observed in the remaining 23 lesions (52.4%). Conclusion ESWT is a viable noninvasive treatment option for early-stage ONFH. It significantly improves clinical outcomes and may halt or delay the radiographic progression of the disease in the precollapse stage.
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Yao C, Yi N, Shen J, Du B, Sun G, Shu H, Zhang C. Clinical reports of surgical dislocation of the hip with sequestrum clearance and impacting bone graft for grade IIIA-IIIB aseptic necrosis of femoral head (ANFH) patients. Oncotarget 2018; 8:50084-50090. [PMID: 28177916 PMCID: PMC5564830 DOI: 10.18632/oncotarget.15095] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 01/25/2017] [Indexed: 11/25/2022] Open
Abstract
Objective To analyze the treatment effect of surgical dislocation of the hip with sequestrum clearance and impacting bone graft in grade IIIA-IIIB aseptic necrosis of femoral head (ANFH) patients. Methods From June 2012 to December 2014, 6 patients (total 8 hips) with grade IIIA-IIIB ANFH were retrospectively followed. All the patients were operated with surgical dislocation of the hip with sequestrum clearance and impacting bone graft. Collapse of the femoral head, healing of the osteotomy, along with Harris hip scores were observed after surgeries. Results All the patients were followed up, the osteotomies were all healed. Only 1 of the 8 hips (12.5%) was collapsed by the last follow-up. Harris hip scores were improved from 54.52 ± 8.16 to 80.53 ± 7.62 (P <0.001). The excellent rate was 87.5%. Conclusion For grade IIIA-IIIB ANFH patients, surgical dislocation with sequestrum clearance and impacting bone graft could possibly achieve satisfactory clinical benefit, particularly for the young patients.
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Affiliation(s)
- Chen Yao
- Orthopedics Joint Group, The Affiliated Hospital of Nanjing University of TCM, Jiangsu Province Hospital of TCM, Nanjing, China
| | - Nan Yi
- Department of Orthopaedics, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Jirong Shen
- Orthopedics Joint Group, The Affiliated Hospital of Nanjing University of TCM, Jiangsu Province Hospital of TCM, Nanjing, China
| | - Bin Du
- Orthopedics Joint Group, The Affiliated Hospital of Nanjing University of TCM, Jiangsu Province Hospital of TCM, Nanjing, China
| | - Guangquan Sun
- Orthopedics Joint Group, The Affiliated Hospital of Nanjing University of TCM, Jiangsu Province Hospital of TCM, Nanjing, China
| | - Hao Shu
- Orthopedics Joint Group, The Affiliated Hospital of Nanjing University of TCM, Jiangsu Province Hospital of TCM, Nanjing, China
| | - Chao Zhang
- Orthopedics Joint Group, The Affiliated Hospital of Nanjing University of TCM, Jiangsu Province Hospital of TCM, Nanjing, China
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Song Y, Du ZW, Yang QW, Ren M, Wang QY, Wang A, Chen GY, Zhao HY, Yu T, Zhang GZ. Association of Genes Variants in RANKL/RANK/OPG Signaling Pathway with the Development of Osteonecrosis of the Femoral Head in Chinese Population. Int J Med Sci 2017; 14:690-697. [PMID: 28824302 PMCID: PMC5562121 DOI: 10.7150/ijms.19124] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 04/21/2017] [Indexed: 12/22/2022] Open
Abstract
The RANKL/RANK/OPG pathway plays an important role in regulating bone remodeling and bone turnover. However, the association of the genes variants with the risk of ONFH has rarely been reported. Here, we analyzed the correlation of the 10 SNPs polymorphisms of RANKL, RANK, OPG, TRAF6, and NFATC1 genes with the risk and development of ONFH in 200 ONFH patients and 177 health controls of Chinese population with using Mass ARRAY® platform. The results showed that the recessive model of NFATC1rs9518 was significantly associated with increased ONFH risk (OR:8.223, P=0.048); the proportion of stage Ⅳ patients in the rs9518TC genotype carriers was statistically higher than that of stage Ⅲ patients (P=0.03); in the T-C haplotype carriers of Naftac1, the proportion of bilateral hips lesions was also significantly enhanced than that of unilateral hip lesions(P=0.05). In addition, the proportion of idiopathic ONFH in the TT genotype carriers of OPGrs2073617 was significantly higher than that of steroid or alcohol-induced ONFH, respectively, while in the TC genotype carriers of the SNP, the proportion of idiopathic ONFH remarkably decreased compared with that of Alcohol-induced ONFH, P=0.021. Our results were first found that NFATC1rs9518 closely associated with the risk and the development of ONFH, while OPGrs2073617 statistically correlated with the etiological classification of ONFH.
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Affiliation(s)
- Yang Song
- Department of Orthopedics of Second Clinical College, Jilin University, Changchun, 130041, China.,The Engineering Research Center of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Changchun, 130041, China
| | - Zhen-Wu Du
- Department of Orthopedics of Second Clinical College, Jilin University, Changchun, 130041, China.,Research Center of Second Clinical College, Jilin University, Changchun, 130041, China.,The Engineering Research Center of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Changchun, 130041, China
| | - Qi-Wei Yang
- Research Center of Second Clinical College, Jilin University, Changchun, 130041, China.,The Engineering Research Center of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Changchun, 130041, China
| | - Ming Ren
- Department of Orthopedics of Second Clinical College, Jilin University, Changchun, 130041, China.,Research Center of Second Clinical College, Jilin University, Changchun, 130041, China
| | - Qing-Yu Wang
- Research Center of Second Clinical College, Jilin University, Changchun, 130041, China.,The Engineering Research Center of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Changchun, 130041, China
| | - Ao Wang
- Department of Orthopedics of Second Clinical College, Jilin University, Changchun, 130041, China.,The Engineering Research Center of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Changchun, 130041, China
| | - Gao-Yang Chen
- Research Center of Second Clinical College, Jilin University, Changchun, 130041, China.,The Engineering Research Center of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Changchun, 130041, China
| | - Hai-Yue Zhao
- Research Center of Second Clinical College, Jilin University, Changchun, 130041, China.,The Engineering Research Center of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Changchun, 130041, China
| | - Tao Yu
- Department of Orthopedics of Second Clinical College, Jilin University, Changchun, 130041, China.,Research Center of Second Clinical College, Jilin University, Changchun, 130041, China
| | - Gui-Zhen Zhang
- Department of Orthopedics of Second Clinical College, Jilin University, Changchun, 130041, China.,Research Center of Second Clinical College, Jilin University, Changchun, 130041, China.,The Engineering Research Center of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Changchun, 130041, China
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