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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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Shock Wave Medicine: A Transformative Evolution in Modern Medicine

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Original Article | Vol 3 | Issue 2 |  July-December 2023 | page: 05-09 | Sunte Li, Xiaoyu Fan, Wei Sun

DOI: https://doi.org/10.13107/jrs.2023.v03.i02.89

Author: Sunte Li [1], Xiaoyu Fan [2], Wei Sun [3, 4]

[1] Friends Central School, Philadelphia, Pennsylvania, USA,
[2] Department of Surgery, Peking University People’s Hospital, Beijing, China,
[3] Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,
[4] Department of Orthopedics, Shockwave Center, China-Japan Friendship Hospital, Chaoyang, Beijing, China.

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

Abstract

Since its inception as extracorporeal shock wave lithotripsy in the 1980s, the landscape of medical treatment has been revolutionized by the evolution of shock wave therapy. Over four decades, this therapy, now known as extracorporeal shock wave therapy (ESWT), has emerged as a cornerstone in modern medicine, redefining treatment paradigms across various medical disciplines. Certainly, despite the promising outcomes witnessed in various medical conditions such as musculoskeletal disorders, wound healing, urinary calculi, and erectile dysfunction,
it is crucial to acknowledge that shock wave therapy’s relatively short clinical tenure necessitates a cautious approach. While its effectiveness has been repeatedly demonstrated, establishing industry-standard protocols through large-scale, prospective randomized controlled trials remains imperative to solidify its standing in medical practice.
The integration of Artificial Intelligence technology holds significant promise for the future of shockwave medicine, enabling personalized treatment plans, real-time feedback, and improved cost-effectiveness.
Keywords: Shock waves, ESWT, Shockwave

 

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How to Cite this article: Li S, Fan X, Sun W. | Shock Wave Medicine: A Transformative Evolution in Modern Medicine. | Journal of Regenerative Science | Jul-Dec 2023; 3(2): 05-09.

 

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