Clinical and Radiological Outcomes of Extracorporeal ShockWave Therapy in Early-Stage Femoral Head Osteonecrosis

Femoral head osteonecrosis is a progressive clinical condition with significant morbidity and long-term disability. Severaltreatment modalities including both surgical and nonsurgical options have been used with variable levels of success. High-energyextracorporeal shock wave therapy is a nonoperative treatment option that has been described for early-stage disease. We aimedto assess the functional and radiological outcomes of extracorporeal shockwave therapy (ESWT) in the treatment of osteonecrosisof the femoral head (ONFH).Methods. Thirty-three hips of 21 patients were included in this study. Adult patients with ONFHof any etiology and in the precollapse stage were included. Clinical (visual analogue scale [VAS] and Harris hip score [HHS]) andradiological (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 outcomeswere 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 thesize of the ONFH was observed although not of clinical significance(p=0.235). MRI revealed significant resolution of bone marrowedema (p<0.003). Regression was observed in 9 lesions (42.9%) and progression in 1 lesion (4.7%); no change was observed in theremaining 23 lesions (52.4%).Conclusion. ESWT is a viable noninvasive treatment option for early-stage ONFH. It significantlyimproves clinical outcomes and may halt or delay the radiographic progression of the disease in the precollapse stage