Extracorporeal shock waves versus bisphosphonates in the treatment of early stage osteonecrosis of the femoral head.

摘要

Problem: Osteonecrosis of the femoral head (ONFH) is a progressively debilitating disease affecting people during their third through sixth decades of life. There are approximately 20,000 newly diagnosed cases of ONFH in the United States annually. Osteonecrosis can lead to severe osteoarthritis, intense pain, and ultimately to total joint destruction. Osteonecrosis is classified into early and late disease, with the defining factor of late stage disease being the radiographic evidence of femoral head collapse. The goal in treatment of early stage ONFH is to prevent or delay femoral head collapse. Recent studies show both bisphosphonates and extracorporeal shock wave therapy (ESWT) to be effective monotherapies in delaying femoral head collapse; however, there have been no studies comparing the outcomes of these two treatments. Methods: Clinical articles available through Pubmed or in the Weill Cornell Medical College Library, published in the last 10 years that examined (1) bisphosphonate treatment for ONFH and (2) ESWT for ONFH. Results: Current literature suggests that both bisphosphonates and ESWT are effective treatments for early stage ONFH. Outcomes for both treatment modalities in terms of alleviation of pain, prevention of femoral head collapse, and Harris Hip Scores are similar. There is currently insufficient evidence available to recommend one treatment modality over the other. Conclusions: While both bisphosphonates and ESWT have been shown to be effective treatment options for early stage ONFH, a long-term prospective, multicenter, clinical trial comparing EWST to bisphosphonates is needed to determine if one treatment method is superior to the other.