Analysis of therapeutic effect of high focused extracorporeal shock wave comprehensive therapy on femoral head bone marrow edema syndrome
Original Article | Vol 3 | Issue 2 | July-December 2023 | page: 35-40 | Ruimeng Duan, Leilei Zhang, Haonan Ling, Jie Guan, Huisheng Shi, Dawei Liang, Xiantao Chen
DOI: https://doi.org/10.13107/jrs.2023.v03.i02.99
Author: Ruimeng Duan [1], Leilei Zhang [1], Haonan Ling [1], Jie Guan [1], Huisheng Shi [1], Dawei Liang [1], Xiantao Chen [1]
[1] Department of Femoral Head Necrosis, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang, Henan, China.
Address of Correspondence
Dr. Xiantao Chen,
Department of Femoral Head Necrosis, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), No. 82 Qiming South Road, Luoyang, Henan Province 471000, China.
E-mail: luoyangzhenggu@163.com
Abstract
Purpose: This study explored the clinical therapeutic effect of high-focused extracorporeal shock wave therapy (HF-ESWT) combined with exercise rehabilitation and drug therapy on femoral head bone marrow edema syndrome (BMES).
Materials and Methods: This study systematically reviewed and analyzed the clinical data of 43 patients with femoral head bone marrow edema who were treated in our hospital from January 2017 to June 2022. Twenty-three patients received HF-ESWT comprehensive treatment. Twenty patients received general treatment including medication and exercise rehabilitation treatment. The treatment methods for Group B patients were the same as Group A, except for not receiving shock wave therapy. Changes in visual analog scale (VAS), Harris score of the hip, and the edema area of region of interest area (ROIA) on hip magnetic resonance imaging (MRI) were analyzed before and after treatment.
Results: Our research found that patients receiving HF-ESWT had significantly reduced VAS compared with general treatment at 1, 2, and 3 months (P < 0.05). We found that HF-ESWT comprehensive treatment had significantly improved hip Harris score compared with general treatment at 2 and 3 months (P < 0.05). HF-ESWT comprehensive treatment had significantly reduced edema area of ROIA on hip MRI compared with general treatment at 1, 2, and 3 months (P < 0.05). In addition, the healing rate was significantly higher in the HF-ESWT
comprehensive treatment group compared with general treatment group (P < 0.05). One of the patients in the group treated with shockwaves developed hip pain that worsened after treatment, three patients developed local skin ecchymosis, and the other patients had no adverse events.
Conclusion: HF-ESWT comprehensive treatment significantly reduced hip pain symptoms, quickly shortened the time for femoral head edema to dissipate, and significantly improved hip function for affected limbs with bone marrow edema syndrome. HF-ESWT comprehensive treatment may be an effective therapeutic strategy for HF-BMES.
Keywords: Extracorporeal shock wave therapy, Bone marrow edema syndrome, Traditional Chinese medicine, Osteonecrosis of the femoral head
References:
1. Miyanishi K, Yamamoto T, Nakashima Y, Shuto T, Jingushi S, Noguchi Y, et al. Subchondral changes in transient osteoporosis of the hip. Skeletal Radiol 2001;30:255-61.
2. Guerra JJ, Steinberg ME. Distinguishing transient osteoporosis from avascular necrosis of the hip. J Bone joint Surg Am 1995;77:616-24.
3. Mirghasemi SA, Trepman E, Sadeghi MS, Rahimi N, Rashidinia S. Bone marrow edema syndrome in the foot and ankle. Foot Ankle Int 2016;37:1364-73.
4. Hofmann S. The painful bone marrow edema syndrome of the hip joint. Wien Klin Wochenschr 2005;117:111-20.
5. Hayes CW, Conway WF, Daniel WW. MR imaging of bone marrow edema pattern: transient osteoporosis, transient bone marrow edema syndrome, or osteonecrosis. Radiographics 1993;13:1001-11; discussion 1012.
6. Cui Q, Jo WL, Koo KH, Cheng EY, Drescher W, Goodman SB, et al. ARCO consensus on the pathogenesis of non-traumatic osteonecrosis of the femoral head. J Korean Med Sci 2021;36:e65.
7. Zhao D, Zhang F, Wang B, Liu B, Li L, Kim SY, et al. Guidelines for clinical diagnosis and treatment of osteonecrosis of the femoral head in adults (2019 version). J Orthop Transl 2020;21:100-10.
8. Eidmann A, Eisert M, Rudert M, Stratos I. Influence of vitamin D and C on bone marrow edema syndrome-a scoping review of the literature. J Clin Med 2022;11:6820.
9. Sansone V, Ravier D, Pascale V, Applefield R, Del Fabbro M, Martinelli N. Extracorporeal shockwave therapy in the treatment of nonunion in long bones: A systematic review and meta-analysis. J Clin Med 2022;11:1977.
10. Simon MJ, Barvencik F, Luttke M, Amling M, Mueller-Wohlfahrt HW, Ueblacker P. Intravenous bisphosphonates and vitamin D in the treatment of bone marrow oedema in professional athletes. Injury 2014;45:981-7.
11. Gao F, Sun W, Li Z, Guo W, Wang W, Cheng L, et al. Extracorporeal shock wave therapy in the treatment of primary bone marrow edema syndrome of the knee: A prospective randomised controlled study. BMC Musculoskelet Disord 2015;16:379.
12. Meng K, Liu Y, Ruan L, Chen L, Chen Y, Liang Y. Suppression of apoptosis in osteocytes, the potential way of natural medicine in the treatment of osteonecrosis of the femoral head. Biomed Pharmacother 2023;162:114403.
13. Qian D, Zhou H, Fan P, Yu T, Patel A, O’Brien M, et al. A traditional Chinese medicine plant extract prevents alcohol-induced osteopenia. Front Pharmacol 2021;12:754088.
14. Qi ZX, Chen L. Effect of Chinese drugs for promoting blood circulation and eliminating blood stasis on vascular endothelial growth factor expression in rabbits with glucocorticoid-induced ischemic necrosis of femoral head. J Tradit Chin Med 2009;29:137-40.
15. Yong EL, Logan S. Menopausal osteoporosis: Screening, prevention and treatment. Singapore Med J 2021;62:159-66.
16. Hofmann S, Engel A, Neuhold A, Leder K, Kramer J, Plenk H Jr. Bone-marrow oedema syndrome and transient osteoporosis of the hip. An MRI-controlled study of treatment by core decompression. J Bone Joint Surg Br 1993;75:210-6.
17. Schweitzer ME, White LM. Does altered biomechanics cause marrow edema? Radiology 1996;198:851-3.
18. Woertler K, Neumann J. Atraumatic bone marrow edema involving the epiphyses. Sem Musculoskelet Radiol 2023;27:45-53.
19. Plenk H Jr., Hofmann S, Eschberger J, Gstettner M, Kramer J, Schneider W, et al. Histomorphology and bone morphometry of the bone marrow edema syndrome of the hip. Clin Orthop Relat Res 1997;334:73-84.
20. Oehler N, Mussawy H, Schmidt T, Rolvien T, Barvencik F. Identification of vitamin D and other bone metabolism parameters as risk factors for primary bone marrow oedema syndrome. BMC Musculoskelet Disord 2018;19:451.
21. Petek D, Hannouche D, Suva D. Osteonecrosis of the femoral head: pathophysiology and current concepts of treatment. EFORT Open Rev 2019;4:85-97.
22. Miranian D, Lanham N, Stensby DJ, Diduch D. Progression and treatment of bilateral knee bone marrow edema syndrome. JBJS Case Connect 2015;5:e391-7.
23. Daly RM, Dalla Via J, Duckham RL, Fraser SF, Helge EW. Exercise for the prevention of osteoporosis in postmenopausal women: An evidence-based guide to the optimal prescription. Braz J Phys Ther 2019;23:170-80.
24. Vasiliadis AV, Zidrou C, Charitoudis G, Beletsiotis A. Single-dose therapy of zoledronic acid for the treatment of primary bone marrow edema syndrome. Cureus 2021;13:e13977.
25. Zippelius T, Strube P, Rohe S, Schlattmann P, Dobrindt O, Caffard T, et al. The use of iloprost in the treatment of bone marrow edema syndrome of the proximal femur: A review and meta-analysis. J Pers Med 2022;12:1757.
26. Gao F, Sun W, Li Z, Guo W, Kush N, Ozaki K. Intractable bone marrow edema syndrome of the hip. Orthopedics 2015;38:e263-70.
27. Mei J, Pang L, Jiang Z. The effect of extracorporeal shock wave on osteonecrosis of femoral head: A systematic review and meta-analysis. Phys Sportsmed 2022;50:280-8.
28. Yang X, Shi L, Zhang T, Gao F, Sun W, Wang P, et al. High-energy focused extracorporeal shock wave prevents the occurrence of glucocorticoid-induced osteonecrosis of the femoral head: A prospective randomized controlled trial. J Orthop Translat 2022;36:145-51.
29. Xie K, Mao Y, Qu X, Dai K, Jia Q, Zhu Z, et al. High-energy extracorporeal shock wave therapy for nontraumatic osteonecrosis of the femoral head. J Orthop Surg Res 2018;13:25.
30. Li B, Wang R, Huang X, Ou Y, Jia Z, Lin S, et al. Extracorporeal shock wave therapy promotes osteogenic differentiation in a rabbit osteoporosis model. Front Endocrinol 2021;12:627718.
31. Ma HZ, Zeng BF, Li XL. Upregulation of VEGF in subchondral bone of necrotic femoral heads in rabbits with use of extracorporeal shock waves. Calcifi Tissue Int 2007;81:124-31.
32. Huang HM, Li XL, Tu SQ, Chen XF, Lu CC, Jiang LH. Effects of roughly focused extracorporeal shock waves therapy on the expressions of bone morphogenetic protein-2 and osteoprotegerin in osteoporotic fracture in rats. Chin Med J (Engl) 2016;129:2567-75.
33. Yu T, Zhang Z, Xie L, Ke X, Liu Y. The influence of traditional Chinese medicine constitutions on the potential repair capacity after osteonecrosis of the femoral head. Complement Ther Med 2016;29:89-93.
34. Weng B, Chen C. Effects of bisphosphonate on osteocyte proliferation and bone formation in patients with diabetic osteoporosis. Comput Math Methods Med 2022;2022:2368564.
35. Liu P, Tu J, Wang W, Li Z, Li Y, Yu X, et al. Effects of mechanical stress stimulation on function and expression mechanism of osteoblasts. Front Bioeng Biotechnol 2022;10:830722.
36. Iolascon G, Resmini G, Tarantino U. Mechanobiology of bone. Aging Clin Exp Res 2013;25:S3-7.
37. Benton MJ, White A. Osteoporosis: Recommendations for resistance exercise and supplementation with calcium and vitamin D to promote bone health. J Community Health Nurs 2006;23:201-11.
How to Cite this article: Duan R, Zhang L, Ling H, Guan J, Shi H, Liang D, Chen X | Analysis of therapeutic effect of high focused extracorporeal shock wave comprehensive therapy on femoral head bone marrow edema syndrome | Journal of Regenerative Science | Jul-Dec 2023; 3(2): 35-40. |
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