in a non-sensate Type 1 diabetic foot. 15th Scientific Congress of the International Society for Medical Shockwave Treatment, 4th–7th, Cartegena, Columbia, 2012.
142Chen YL, Chen KH, Yin TC, Huang TH, Yuen CM, Chung SY, et al: Extracorporeal shock wave therapy effectively prevented diabetic neuropathy. Am J Trans Res 2015;7:2543–2560.
143Chen TW, Lin CW, Lee CL, Chen CH, Chen YJ, Lin TY, Huang MH: The efficacy of shock wave therapy in patients with knee osteoarthritis and popliteal cyamellla. Kaohsiung J Med Sci 2014;30:362–370.
144Zhao Z, Jing R, Shi Z, Zhao B, Ai Q, Xing G: Efficacy of extracorporeal shockwave therapy for knee osteoarthritis: a randomized controlled trial. J Surg Res 2013;185:661–666.
145Kim JH, Kim JY, Choi CM, Lee JK, Kee HS, Jung KI, Yoon SR: The dose-related effects of extracorporeal shock wave therapy for knee osteoarthritis. Ann Rehabil Med 2015;39:616–623.
146Vincent KC, Takai B, Craig J, McDonald D: Medical shockwaves for chronic low back pain: a case series. 18th Scientific Congress of the International Society for Medical Shockwave Treatment, 16th–18th, Mendoza, Argentina, July 2015.
147Freitag K: 2016, Uterine Fibroids and Shockwaves. 19th 18th Scientific Congress of the International Society for Medical Shockwave Treatment, 13th–15th July, 2017.
148Craig K, d’Agostino C, Poratt D, Walker M: Original hypothesis: extracorporeal shockwaves as a homeostatic autoimmune restorative treatment (HART) for Type 1 diabetes mellitus. Med Hypotheses 2014;83:250–253.
Kenneth Craig S. Vincent, MD
Kompass Health Associates
27A Haughey Avenue
Three Kings 1042, Aukland (New Zealand)
E-Mail [email protected]
Section II: Musculoskeletal Disorders
Wang C-J, Schaden W, Ko J-Y (eds): Shockwave Medicine.
Transl Res Biomed. Basel, Karger, 2018, vol 6, pp 17–26 (DOI: 10.1159/000485056)
______________________
Development of Extracorporeal Shockwave Therapy for Treatment of Osteonecrosis of the Femoral Head
Jai-Hong Chenga, c · Shan-Ling Hsua, b · Ching-Jen Wanga, b
aCenter for Shockwave Medicine and Tissue Engineering, bDepartment of Orthopedic Surgery, and cMedical Research, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
______________________
Abstract
Osteonecrosis of the femoral head (ONFH), also known as avascular necrosis of the femoral head, is usually caused by the death of bone tissue due to disruption of blood supply. Multiple factors can induce ONFH such as drug abuse alcohol overuse overweight, trauma, corticosteroid, chemotherapy, and idiopathic. Symptomatic hips with early ONFH are treated conservatively, while joint replacement is indicated in late stage. For early stages, core decompression with or without bone grafting is recommended to preserve the femoral head. However, the results are inconsistent. Some achieved limited success but none universal. Some reported poor results that many patients eventually undergo hip replacement surgery. Total hip replacement in young patients is at risk for loosening and dislocation. Other methods of treatment included non-weight-bearing therapy, hyperbaric oxygen therapy, and extracorporeal shockwave therapy (ESWT). ESWT has been used to treat various tendinopathies and fractures with poor bone healing with reasonable success for 30–40 years. Recently, ESWT was investigated in the treatment of ONFH. ESWT is a noninvasive device that exerts beneficial effects of improving bone regeneration, anti-inflammatory, pain relief, and angiogenesis in the treatment of ONFH. Many experiments showed that ESWT is more effective than core decompression with or without bone grafting for patients with early stage of ONFH. The purpose of the present article is to review the clinical trials and animal studies of ESWT on ONFH with perspective and challenge in the future.
© 2018 S. Karger AG, Basel
Osteonecrosis of the Femoral Head and Extracorporeal Shockwave Therapy
The etiology of osteonecrosis of the femoral head (ONFH) is multifactorial including alcohol abuse, overweight, trauma, corticosteroid usage, chemotherapy, thalassemia, pregnancy, HIV infection, organ transplantation, ischemia, systemic lupus erythematosus (SLE), and idiopathic [1, 2]. ONFH is usually progressive that leads to collapse or fracture of femoral head, and the disease finally leads to the femoral head collapse, destruction and degenerative changes of hip joint. Several prognostic factors could be observed for the progression of ONFH including the extent and location of the osteonecrotic lesion, lesion size, bone marrow edema in the proximal femur, and genetic factors [2, 3]. Imaging studies, particularly MRI, are the major methods that can accurately evaluate and assess the progression of ONFH. These imaging studies may also assess the risks of femoral head collapse from patients’ perspective and clarify the patient expectation from the perspective of the history of the natural development of the disease. There are several classification systems to identify and staging the ONFH, including Ficat and Arlet classification, Steinberg-the University of Pennsylvania staging system, Association Research Circulation Osseous (ARCO), and the Japanese Orthopaedic Association classification systems (Table 1) [4]. These classification systems provide information of ONFH on the prognosis and assist with treatment decision.
There are many options for treating ONFH including non-weight-bearing (NWB) therapy, pharmacologic treatment, physical support, hyperbaric oxygen (HBO) therapy, core decompression, extracorporeal shockwave therapy (ESWT), and surgery [5]. The purpose of treatment for ONFH is to prevent collapse or delay the stage progression of the femoral head. However, the optimal treatment for ONFH is still not well defined and remains controversial. In general, patients with early ONFH prefer conservative nonsurgical management, but unsatisfactory functional outcomes were noticed in most patients. There is still no completely effective method, even with regard to surgery for ONFH. Better results often rely on early diagnosis and treatment. The type of surgery is dependent on the stage of ONFH images [6, 7]. The operative treatment such as the core decompression with or without bone grafting is the most common surgical procedure for precollapse of ONFH and is regarded
