High energy focused extracorporeal shock wave therapy for early and mid-stage femoral head necrosis: A single center retrospective cohort study

Original Article | Vol 3 | Issue 2 |  July-December 2023 | page: 29-34 | Leilei Zhang, Xuanye Zhu, Haonan Ling, Ruimeng Duan, Ying Zhang, Youwen Liu, Xiantao Chen

DOI: https://doi.org/10.13107/jrs.2023.v03.i02.97


Author: Leilei Zhang [1, 2], Xuanye Zhu [2], Haonan Ling [1], Ruimeng Duan [1], Ying Zhang [1], Youwen Liu [1], Xiantao Chen [1]

[1] Center of hip Surgery, Henan Luoyang Orthopedic-Traumatological Hospital, Orthopedic Hospital of Henan Province, Luoyang, China.
[2] Henan University of Traditional Chinese Medicine, Zhengzhou, China.

Address of Correspondence
Dr. Youwen Liu and Xiantao Chen,
Medical Center of Hip Surgery, Henan Luoyang Orthopedic- Traumatological Hospital, Orthopedic Hospital of Henan Province, No. 82, South Qiming Road, 471002, Luoyang, China.
E-mail: luoyangzhenggu@139.com


Abstract

Background: Research has shown that extracorporeal shock wave therapy has a certain therapeutic effect on the osteonecrosis of the femoral head (ONFH). However, the sample sizes are relatively small. The aim of this study is to evaluate and investigate the clinical efficacy and safety of high-energy extracorporeal shock wave treatment (ESWT) in the management of early and mid-stage ONFH by observing a large size clinical sample.
Materials & Methods: 453 patients with stage I–III ONFH treated ESWT in our hospital between June 2019 to August 2021, are included. The visual analog pain scale (VAS), Harris hip score, radiography, and magnetic resonance imaging were used to estimate treatment results. The progression of ONFH was evaluated by imaging examination and clinical outcomes.
Results: The mean follow-up was 39.81±7.94 months (range 26 to 50 months). The mean VAS decreased from 5.54 ± 1.19 before ESWT treatment to 1.92 ± 0.43 points at the 12 months follow-up (p < 0.001). The mean Harris hip score improved from 75.51 ± 5.14 before ESWT treatment, to 92.21 ± 4.53 at the 12 months follow-up (p < 0.001). The clinical success(improvement) was observed in 85.71% of ARCO stage I patients, 48.09% of ARCO stage II patients, and 49.15% of ARCO stage III patients. Imaging success (no worsening of clinical images) was observed in 12.38% stage I hips, 28.37% of stage II hips, and 27.12% of stage III hips, respectively. The hip joint survival rate of stage Ⅱ and stage Ⅲ patients was 86.51% and 77.97% (P<0.05).
Conclusions: The result of the current study suggests that ESWT definitely represents an effective, reliable, and safe therapeutic method for early and middle stages of ONFH with bone marrow edema syndrome (BMES), and should be recommended as a therapeutic option.
Keywords: High-energy extracorporeal shock wave therapy, Osteonecrosis, Femoral head, Bone marrow edema.


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How to Cite this article: Zhang L, Zhu X, Ling H, Duan R, Zhang Y, Liu Y, Chen X | High energy focused extracorporeal shock wave therapy for early and mid-stage femoral head necrosis: A single center retrospective cohort study | Journal of Regenerative Science | Jul-Dec 2023; 3(2): 29-34.

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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


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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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A novel treatment method for ankylosing spondylitis combined with sacroiliac joint bone marrow edema

Original Article | Vol 3 | Issue 2 |  July-December 2023 | page: 41-46 | Leilei Zhang, Xuanye Zhu, Haonan Ling, Wanyi Zhang, Ying Zhang, Youwen Liu, Xiantao Chen

DOI: https://doi.org/10.13107/jrs.2023.v03.i02.101


Author: Leilei Zhang [1], Xuanye Zhu [2], Haonan Ling [1], Wanyi Zhang [1], Ying Zhang [1], Youwen Liu [1], Xiantao Chen [1]

[1] Center of hip Surgery, Henan Luoyang Orthopedic-Traumatological Hospital, Orthopedic Hospital of Henan Province, Luoyang, China.
[2] Henan University of Traditional Chinese Medicine, zhengzhou, China.

Address of Correspondence
Dr. Center of Hip Surgery, Henan Luoyang Orthopedic-Traumatological Hospital, Orthopedic Hospital of Henan Province, No. 82, South Qiming Road, 471002, Luoyang, China.
E-mail: luoyangzhenggu@139.com


Abstract

Objective: To investigate whether high-energy extracorporeal shock wave therapy (ESWT) combined with conventional oral medicine as a potential novel therapeutic approach for the treatment of ankylosing spondylitis (AS)combined with sacroiliac joint bone marrow edema.
Materials & Methods: 40 patients were divided into two groups and were treated with or without ESWT in combination with conventional oral medicine. A visual analog scale (VAS) score of spinal pain, as well as indicators of spinal mobility, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) scores, inflammatory index (C-reactive protein, blood cell sedimentation rate), and other indicators were compared between the two groups. The Spondyloarthritis Research Consortium of Canada (SPARCC) scoring system was used to evaluate pain and structural damage in the sacroiliac joint.
Results: (1) After one month of treatment (T1), VAS, BASDAI, BASFI, and SPARCC scores were lower in both groups than at the start of treatment (T0) (P < 0.05), with greater decreases observed in the treatment group (P < 0.05). (2) Also, at T1, indicators of spinal mobility for the two groups were improved (P < 0.05). (3) ESR and C-reactive protein levels for the two groups decreased significantly at T1 versus T0 (P < 0.05).
Conclusion: ESWT combined with oral medication can significantly relieve pain and improve clinical functional symptoms for patients with AS. It can also reduce sacroiliac joint bone marrow edema and control the inflammatory reaction in the sacroiliac joint, which represents a novel, effective, reliable, and safe clinical treatment therapeutic method.
Keywords: Ankylosing spondylitis, Sacroiliac joint, extracorporeal shock wave therapy, oral medicine.


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How to Cite this article: Zhang L, Zhu X, Ling H, Zhang W, Zhang Y, Liu Y, Chen X | A novel treatment method for ankylosing spondylitis combined with sacroiliac joint bone marrow edema | Journal of Regenerative Science | Jul-Dec 2023; 3(2): 41-46.

 

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Clinical Study on Appropriate Energy of Extracorporeal Shock Wave for Rotator Cuff Non-calcific Tendinopathy Treatment

Original Article | Vol 3 | Issue 2 |  July-December 2023 | page: 47-51 | Jin Xi, Li Jie, Li Jin, Luo Hao, Zhang Liheng

DOI: https://doi.org/10.13107/jrs.2023.v03.i02.103


Author: Jin Xi [1], Li Jie [2], Li Jin [2], Luo Hao [2], Zhang Liheng [2]

[1] Graduate Union of Changchun University of Chinese Medicine, Changchun China.
[2] Department of Sports medicine and joint surgery Jilin Provincial People’s Hospital, Changchun, China.

Address of Correspondence
Dr. Zhang Liheng,
Department of Sports medicine and joint surgery Jilin Provincial People’s Hospital, Changchun, China.
E-mail: 1987174487@qq.com


Abstract

Objective: This study aims to investigate the short-term clinical efficacy of extracorporeal shock waves with different energy levels on rotator cuff non-calcific tendinopathy.
Materials and Methods: A total of 139 patients with rotator cuff rotator non-calcific tendinopathy were randomly divided into eight groups based on the different energy levels of the Dornier Aries smart focus shock wave therapy device: Level 5, 2000 shocks (0.062 mJ/mm2), Level 6, 2000 shocks (0.084 mJ/mm2), Level 7, 2000 shocks (0.096 mJ/mm2), Level 8, 2000 shocks (0.117 mJ/mm2), Level 5, 3000 shocks (0.062 mJ/mm2), Level 6, 3000 shocks (0.084 mJ/mm2), Level 7, 3000 shocks (0.096 mJ/mm2), and Level 8, 3000 shocks (0.117 mJ/mm2). Each
group received shock wave treatment corresponding to the respective energy level and shock count. The visual analogue scale (VAS) and Constant-Murley score (CMS) were compared before and 1, 2, and 4 weeks after treatment to determine the short-term efficacy.
Results: The VAS scores of all groups significantly decreased at 1, 2, and 4 weeks after treatment compared to before treatment. The VAS score of the Level 7, 2000 shocks (0.096 mJ/mm2) group was significantly lower than the other groups (P < 0.05). The CMS scores of all groups significantly increased at 1, 2, and 4 weeks after treatment compared to before treatment. The CMS score of the Level 7, 2000 shocks (0.096 mJ/mm2) group was significantly higher than the other groups (P < 0.05). There was significant statistical difference in the effective rate among the eight groups (P > 0.05). No serious adverse reactions were observed in any group before or after the treatment.
Conclusion: Extracorporeal shock wave therapy for rotator cuff rotator non-calcific tendinopathy can alleviate shoulder joint pain, improve shoulder joint function, and enhance patients quality of life with good efficacy. The optimal therapeutic effect was observed at an energy level of 0.096 mJ/mm2 and 2000 shocks.
Keywords: Rotator cuff injury, Rotator cuff non-calcific tendinopathy, Extracorporeal shock wave therapy


References:

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How to Cite this article: Xi J, Jie L, Jin L, Hao L, Liheng Z | Clinical Study on Appropriate Energy of Extracorporeal Shock Wave for Rotator Cuff Non-calcific Tendinopathy Treatment. | Journal of Regenerative Science | Jul-Dec 2023; 3(2): 47-51.

 

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Extracorporeal Shockwave in Combination with Arthroscopic Surgery for Calcified Supraspinatus Tendinitis

Original Article | Vol 3 | Issue 2 |  July-December 2023 | page: 52-56 | Jin Li, Jie Li, Xi Jin, Sheng Liu, Shaohong Zhao, Liheng Zhang

DOI: https://doi.org/10.13107/jrs.2023.v03.i02.105


Author: Jin Li [1, 2], Jie Li [1], Xi Jin [2], Sheng Liu [2], Shaohong Zhao [2], Liheng Zhang [1]

[1] Department of Sports Medicine and Joint Surgery, Jilin Province People’s Hospital, , Changchun, China,
[2] Graduate Union of Changchun University of Chinese Medicine, Changchun, China.

Address of Correspondence

Dr. Liheng Zhang,
Department of Sports Medicine and Joint Surgery, Jilin Province People’s Hospital, Changchun, China.
E-mail: 1987174487@qq.com


Abstract

Objective: Exploring the therapeutic effect of extracorporeal shockwave combined with Arthroscopic Surgery on calcified supraspinatus tendinitis.
Materials and Methods: Sixty patients with calcific supraspinatus tendinitis who received treatment in our hospital from June 2022 to June 2023 were randomly divided into two groups. All patients had disease lasting more than 6 months. The control group received extracorporeal shockwave therapy (ESWT), while the observation group, after undergoing arthroscopic debridement of calcific deposits in the joint, began receiving the same ESWT as the control group after 2 weeks. The differences in Visual Analog Scale (VAS) score, University of California at Los Angeles (UCLA) score, and Constant–Murley score between the two groups before and after treatment were recorded and compared.
Results: Before treatment, there was no significant difference in VAS score, UCLA score, and Constant–Murley Scale (CMS) score between the two groups of patients (P > 0.05); compared with before treatment, both groups of patients showed a significant decrease in VAS scores after 1 and 2 months of treatment (P < 0.05). After 1 and 2 months of treatment, the VAS scores of the observation group were significantly lower than the ones of the control group (P < 0.05). Compared with before treatment, the UCLA score and CMS score of both groups of patients significantly increased after 1 and 2 months of treatment (P < 0.05). After 1 and 2 months of treatment, the UCLA score and CMS score of the observation group were significantly higher than those of the control group (P < 0.05).
Conclusion: The combination of extracorporeal shockwave and arthroscopy has a significant therapeutic effect on calcified supraspinatus tendinitis, helping to improve shoulder joint function and effectively alleviate pain in patients.

Keywords: Extracorporeal shockwave, Arthroscopy, Calcifying supraspinatus tendinitis, Shoulder joint function, Pain.


References:

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How to Cite this article: Li J, Li J, Jin X, Liu S, Zhao S, Zhang L | Extracorporeal Shockwave in Combination with Arthroscopy for Calcified Supraspinatus Tendonitis | Journal of Regenerative Science | Jul-Dec 2023; 3(2): 52-56.

 

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Extracorporeal Shock Wave Treatment for Calcifying Tendinitis of the Shoulder: A case report and literature review

Original Article | Vol 3 | Issue 2 |  July-December 2023 | page: 57-61 | Dehui Song, Chengxin Li, Wei Sun, Yu Zhou, Fuqiang Gao, Li Zirong

DOI: https://doi.org/10.13107/jrs.2023.v03.i02.107


Author: Dehui Song [1], Chengxin Li [2], Wei Sun [3, 4], Yu Zhou [1], Fuqiang Gao [3], Li Zirong [1]

[1] Peking University Health Science Center, China-Japan Friendship School of Clinical Medicine, Beijing, China,
[2] Department of Orthopedic, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China,
[3] Department of Orthopedics, Shockwave Center, China-Japan Friendship Hospital, Beijing, China,
[4] Department of Orthopedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Address of Correspondence

Dr. Wei Sun,
Department of Orthopedics, Shockwave Center, China-Japan Friendship Hospital, Beijing, China/Department of Orthopedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
E-mail: wei.sun@pennmedicine.upenn.edu


Abstract

Background: Calcifying tendinitis of the shoulder (CTS), also known as rotator cuff calcific tendinitis, is a self-limiting shoulder disorder primarily characterized by inflammation surrounding hydroxyapatite crystal deposits in the tendons of the rotator cuff. Given the specific characteristics of the shoulder joint and the uncertainty regarding the efficacy of various treatments for CTS, no standardized treatment protocol has been established. However, numerous studies have demonstrated that extracorporeal shock wave therapy (ESWT) is effective in alleviating pain and improving joint function in patients with calcifying tendinitis of the shoulder. The therapeutic process works using high-energy shock waves to break down deposits of calcification, reduce local inflammation, and promote tissue healing. The purpose of this article is to present a case of symptomatic calcifying tendinopathy involving the rotator cuff and further demonstrate that ESWT has good efficacy in the treatment of musculoskeletal diseases.
Results: In this case, a 39-year-old woman with a 6-month history of shoulder pain and limited range of motion (ROM) was diagnosed with calcifying tendinitis of the shoulder. A single session of shock wave therapy resulted in the complete resolution of calcific deposits and the patient’s symptoms, leading to a return to her normal ROM and improved quality of life.
Conclusion: ESWT has been shown to be a good alternative to surgery for the treatment of calcifying tendinitis of the shoulder (CTS). It can significantly alleviate pain, improve shoulder function, and reduce the average size of calcium deposits. It might be the first choice for treating shoulder tendinopathy due to its effectiveness and safety.
Keywords: Calcifying tendinitis, Shoulder pain, Extracorporeal shock wave treatment, Case report


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How to Cite this article: Song D, Li C, Sun W, Zhou Y, Gao F, Zirong L | Extracorporeal Shock Wave Treatment for Calcifying Tendinitis of the Shoulder: A case report and literature review. | Journal of Regenerative Science | Jul-Dec 2023; 3(2): 57-61.

 

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