The effect of extracorporeal shock wave on osteonecrosis of femoral head:a systematic review and meta-analysis

Introduction This study aims to determine whether ESWT (extracorporeal shock wave therapy) affects ONFH (osteonecrosis of femoral head) in clinical outcomes and radiography outcomes. Method Two authors independently search the papers on the treatment of femoral head necrosis with extracorporeal shock wave in CNKI (China National Knowledge Infrastructure), VIP (China Science and Technology Journal Database), CSPD (China Science Periodical Database), Pubmed, Embase, and Springer databases. Search period from the inception dates to 2 June 2020 and have no limitations in language; two authors independently conducted a quality evaluation and data extraction for included studies and performed a meta-analysis with data extracted and calculate by using RevMan5. Registration number: CRD42020213580. Result Nine articles with 409 patients are included in this meta-analysis. The pooled results of HHS (Harris hip score) in eight studies with 337 hips show that ESWT achieves higher Harris scores compared to before treatment (MD = -19.95; 95% CI: -26.27, -13.64) and the difference is statistically significant (p < 0.01). The pooled results of VAS (visual analogue score) in seven studies with 253 hips show that ESWT achieves lower VAS compared to baseline (MD = 2.77; 95% CI: 1.88, 3.65) and the difference is statistically significant (p < 0.01). The pooled results of lesion of MRI with 164 hips show that ESWT decreases the lesion area of MRI (SMD = 1.03; CI: 0.75,1.30) and the difference is statistically significant (p < 0.01). Conclusion ESWT has an effect on pain relief and has a limited effect on motion function. Its effect may be better than surgical groups (core decompression and core decompression with bone grafting). But it cannot decrease the lesion area of the femoral head on MRI and stop disease progression.