Ann Rehabil Med.  2016 Oct;40(5):871-877. 10.5535/arm.2016.40.5.871.

Effectiveness of Lower Energy Density Extracorporeal Shock Wave Therapy in the Early Stage of Avascular Necrosis of the Femoral Head

• Han Y
• Lee JK
• Lee BY
• Kee HS
• Jung KI
• Yoon SR

• KMID: 2382919
• DOI: http://doi.org/10.5535/arm.2016.40.5.871

Abstract

OBJECTIVE
To evaluate the effectiveness of lower energy flux density (EFD) extracorporeal shock wave therapy (ESWT) in the early stage of avascular necrosis (AVN) of the femoral head.
METHODS
Nineteen patients and 30 hips were enrolled. All subjects received 4 weekly sessions of ESWT, at different energy levels; group A (n=15; 1,000 shocks/session, EFD per shock 0.12 mJ/mm²) and group B (n=15; 1,000 shocks/session, EFD per shock 0.32 mJ/mm²). We measured pain by using the visual analog scale (VAS), and disability by using the Harris hip score, Hip dysfunction and Osteoarthritis Outcome Score (HOOS), and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC). To determine the effect of the lower EFD ESWT, we assessed the VAS, Harris hip score, HOOS, WOMAC of the subjects before and at 1, 3, and 6 months.
RESULTS
In both groups, the VAS, Harris hip score, HOOS, and WOMAC scores improved over time (p<0.05).
CONCLUSION
Lower EFD ESWT may be an effective method to improve the function and to relieve pain in the early stage of AVN.

Keyword

Femoral head necrosis; High-energy shock waves; Disability evaluation; Treatment outcome

MeSH Terms

Disability Evaluation
Head*
High-Energy Shock Waves
Hip
Humans
Methods
Necrosis*
Ontario
Osteoarthritis
Shock*
Treatment Outcome
Visual Analog Scale

Figure

• 

  Fig. 1 A flow diagram, showing the treatment process and assessment. ESWT, extracorporeal shock wave therapy; EFD, energy flux density.

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  Fig. 2 The visual analogue scale (VAS) score at baseline and at 1-, 3-, and 6-month follow-ups after extracorporeal shock wave therapy in both groups. This figure shows significant improvement in the VAS score in both groups, for the entire period (*p<0.05 for time effect, *p<0.05 for group-time interaction). Group A, 0.12 mJ/mm2 energy group; group B, 0.32 mJ/mm2 energy group.

• 

  Fig. 3 The Harris hip (HH) score at baseline and at 1-, 3-, and 6-month follow-ups after extracorporeal shock wave therapy in both groups. This figure shows significant improvement in the HH score in both groups, for the entire period (*p<0.05 for time effect, *p<0.05 for group-time interaction). Group A, 0.12 mJ/mm2 energy group; group B, 0.32 mJ/mm2 energy group.

• 

  Fig. 4 The Hip dysfunction and Osteoarthritis Outcome Score (HOOS) score at baseline and at 1-, 3-, and 6-month follow-ups after extracorporeal shock wave therapy in both groups. This figure shows significant improvement in the HOOS score in both groups, for entire period (*p<0.05 for time effect, *p<0.05 for group-time interaction). Group A, 0.12 mJ/mm2 energy group; group B, 0.32 mJ/mm2 energy group.

• 

  Fig. 5 The Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score at baseline and at 1-, 3-, and 6-month follow-ups after extracorporeal shock wave therapy in both groups. This figure shows significant improvement in the WOMAC score in both groups, for entire period (*p<0.05 for time effect, *p<0.05 for group-time interaction). Group A, 0.12 mJ/mm2 energy group; group B, 0.32 mJ/mm2 energy group.

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