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Guidelines for High-energy Focused Shock Wave Therapy in Non-traumatic Osteonecrosis of the Femoral Head in Adults (2025 Edition)

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Original Article | Vol 5 | Issue 2 |  July-December 2025 | page: 2-12 | Tianyang Liu, Wei Sun, Fuqiang Gao

DOI: https://doi.org/10.13107/jrs.2025.v05.i02.171

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2025; The Author(s).

Submitted Date: 05 Aug 2025, Review Date: 23 Sep 2025, Accepted Date: 09 Nov 2025 & Published: 30 Dec 2025

Author: Tianyang Liu [1], Wei Sun [2], Fuqiang Gao [1]
[1] Department of Orthopedics, Osteonecrosis and Hip Dysplasia Hip Preservation Center, China-Japan Friendship Hospital, Beijing, China.
[2] Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, USA.

Address of Correspondence
Dr. Fuqiang Gao,
Department of Orthopedics, Osteonecrosis and Hip Dysplasia Hip Preservation Center, China-Japan Friendship Hospital, Beijing, China.
E-mail: gaofuqiang@bjmu.edu.cn/gaofuqiang@hsc.pku.edu.cn

Abstract

Non-traumatic osteonecrosis of the femoral head (NONFH) is a common and refractory orthopedic disease that leads to disability and is a frequent cause of hip joint dysfunction and pain. This condition imposes a significant burden on patients, their families, and society. Extracorporeal shock wave therapy (ESWT) is a non-invasive, safe, and effective treatment that has been widely used in the clinical management of musculoskeletal diseases, including NONFH. However, the current application of ESWT for NONFH lacks a unified consensus regarding treatment protocols and evaluation methods, limiting its widespread adoption. Consequently, developing standardized, scientific, and effective ESWT interventions for patients with early- and mid-stage NONFH remains a critical concern for clinicians. These guidelines have been developed under the organization of the Third Medical Center of the Chinese PLA General Hospital and the China–Japan Friendship Hospital, with contributions from the Shock Wave Medical Professional Committee of the Chinese Research Hospital Association and experts in ONFH and ESWT. It references the latest domestic and international literature, integrates domestic clinical experience and actual conditions, and employs the modified 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) levels of evidence and grades of recommendation. Guidelines are developed under the guidance of the WHO Handbook for Guideline Development (2014 Edition) and the Chinese Principles for the Development and Revision of Clinical Guidelines (2022 Edition). The Appraisal of Guidelines for Research and Evaluation II (AGREE II), Reporting Items for Practice Guidelines in Healthcare, and the Appraisal of Guidelines for Research and Evaluation in China (AGREE-China) were also referenced for evaluation. Nine clinical questions of utmost concern to physicians were selected, leading to the formation of nine evidence-based recommendations. These guidelines aim to provide constructive recommendations and a basis for the promotion and application of ESWT in the treatment of NONFH, thereby enhancing the scientific rigor and standardization of ESWT.
Keywords: Shockwave, Extracorporeal shock wave therapy, Osteonecrosis of the femoral head, Evidence-based medicine, Physical therapy

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How to Cite this article: XLiu T, Sun W, Gao F. Guidelines for High-energy Focused Shock Wave Therapy in Non-traumatic Osteonecrosis of the Femoral Head in Adults (2025 Edition). July-Decemnber 2025;5(2):2-12.

 

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Chinese Expert Consensus on Clinical Diagnosis and Treatment Technique of Osteonecrosis of the Femoral Head (2023)

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Original Article | Vol 3 | Issue 2 |  July-December 2023 | page: 14-21 | Wei Sun, Fuqiang Gao, Zirong Li, Xin Xu, Jike Lu

DOI: https://doi.org/10.13107/jrs.2023.v03.i02.93

Author: Wei Sun [1, 2], Fuqiang Gao [1], Zirong Li [1], Xin Xu [1], Jike Lu [1]

[1] Centre for Osteonecrosis and Joint-Preserving and Reconstruction, Department of Orthopedics, China-Japan Friendship Hospital, Beijing, 100029, China.
[2] Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Address of Correspondence
Dr. Wei Sun,
Centre for Osteonecrosis and Joint-Preserving and Reconstruction, Department of Orthopedics, China-Japan Friendship Hospital, Beijing, 100029, China. /Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pennsylvania, USA.
E-mail: lizirongon@163.com

Abstract

Osteonecrosis of the femoral head (ONFH) is a common and refractory disease. Although the exact pathophysiological mechanism is not fully understood, it is believed to be closely related to the interruption of intra-bone circulation and eventual bone tissue death. The prevention and treatment of ONFH are always a great challenge for orthopedists. The diagnostic level of ONFH has been continuously improved with the development of imaging techniques such as magnetic resource imaging and the in-depth understanding of the disease in recent years. There are many treatment methods for ONFH, which are generally considered individually and comprehensively according to factors such as the patient’s age, osteonecrosis stage, classification, and compliance with joint-sparing treatment. There is currently no unified standard. ONFH staging and classification play an important reference value for doctors to choose treatment options. In recent years, based on the characteristics of ONFH in Chinese people, the academic community has proposed Chinese staging and China-Japan Friendship Hospital classification. The consensus also introduces them together with the international ARCO staging to provide guidance for individualized treatment of ONFH. To further standardize the diagnosis of ONFH and expand the treatment of ONFH, the Association Related to Osseous Microcirculation Chinese Microcirculation Society organized domestic experts in the field of ONFH to jointly formulate the expert consensus, to provide reference for the standardized diagnosis of ONFH and the selection of individualized diagnosis and treatment techniques.
Keywords: Expert consensus, Osteonecrosis of the femoral head, Diagnosis, Treatment technique

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3. Haupt G. Use of extracorporeal shock waves in the treatment of pseudarthrosis, tendinopathy and other orthopedic diseases. J Urol 1997;158:4-11.
4. Auersperg V, Trieb K. Extracorporeal shock wave therapy: An update. EFORT Open Rev 2020;5:584-92.
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20. Abbas A, Khan Z, Veqar Z. Dose dependent effects of extracorporeal shockwave therapy on pain and function in osteonecrosis of femoral head: A systematic review. J Clin Orthop Trauma 2023;45:102275.
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How to Cite this article: Sun W, Gao F, Li Z, Xu X | Chinese Expert Consensus on Clinical Diagnosis and Treatment Technique of Osteonecrosis of the Femoral Head (2023). | Journal of Regenerative Science | Jul-Dec 2023; 3(2): 14-21.

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Analysis of therapeutic effect of high focused extracorporeal shock wave comprehensive therapy on femoral head bone marrow edema syndrome

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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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