RESEARCH - Extracorporeal shockwave therapy shows regeneration in hip necrosis

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Rheumatology 2008 47(4):542-546; doi:10.1093/rheumatology/ken020

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.

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.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/47/4/542?etoc

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