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Rheumatology 2008 47(4):542-546; doi:10.1093/rheumatology/ken020
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Extracorporeal shockwave therapy shows regeneration in hip necrosis

C.-J. Wang1, F.-S. Wang2, J.-Y. Ko1, H.-Y. Huang3, C.-J. Chen4, Y.-C. Sun2 and Y.-J. Yang2

1Department of Orthopedic Surgery, 2Department of Medical Research, 3Department of Pathology and 4Department of Arthritis and Rheumatology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University School of Medicine, Taiwan.

Correspondence to: F.-S. Wang, Department of Medical Research, Chang Gung Memorial Hospital-Kaohsiung Medical Center, 123 Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung, 833 Taiwan. E-mail: w281211{at}adm.cgmh.org.tw


  Abstract

Objectives. The effect of shockwave in osteonecrosis of the femoral head (ONFH) is poorly understood. The purpose of this study was to investigate the regeneration effects of shockwave in ONFH.

Methods. This study consisted of 14 femoral heads from 14 patients undergoing total hip arthroplasty for ONFH. Seven patients with seven hips who received shockwave prior to surgery were designated as the study group, whereas, seven patients with seven hips who did not receive shockwave were assigned to the control group. Both groups showed similar demographic characteristics. The femoral heads were investigated with histopathological examination and immunohistochemical analysis with von Willebrand factor (vWF), VEGF, platelet endothelial cell adhesion molecule-1 (PECAM-1) also referred to as (CD 31) and vascular cell adhesion molecule (VCAM) for angiogenesis, and with proliferation cell nuclear antigen (PCNA), Dickkopf-1 (DKK1) and Winless 3a (Wnt 3) for bone remodelling and regeneration.

Results. In histopathological examination, the study group showed significantly more viable bone and less necrotic bone, higher cell concentration and more cell activities including phagocytosis than the control group. In immunohistochemical analysis, the study group showed significant increases in vWF (P < 0.01), VEGF (P = 0.0012) and CD 31 (P = 0.0023), Wnt3 (P = 0.008) and PCNA (P = 0.0011), and decreases in VCAM (P = 0.0013) and DKK1 (P = 0.0007) than the control group.

Conclusions. Shockwave treatment significantly promotes angiogenesis and bone remodelling than the control. It appears that application of shockwave results in regeneration effects in hips with ONFH.

KEY WORDS: Extracorporeal shockwave, Regeneration, Osteonecrosis, Femoral head

Submitted 6 August 2007; revised version accepted 9 January 2008.
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