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Table 5 Characteristics of studies and intervention details for osteonecrosis of the femoral head (ONFH)

From: The effects of shockwave therapy on musculoskeletal conditions based on changes in imaging: a systematic review and meta-analysis with meta-regression

Author (year)

Study design

N

Mean age

±SD or (range)

Mean symptoms duration ± SD or (range), months

Area of SWT application

Dosage in impulses*EFD (mJ/mm2)/bar

No. of sessions

Interval between sessions

Co- intervention, anesthesia

Algarni (2018) [61]

Prospective open design

21 (33 hips)

37.5 ± 4.8

6 ± 3

The hip was fixed in adduction and internal rotation, ONFH was marked using fluoroscopy in 2–3 points depending on the size of the lesion

3000–4500 (1500 pulses for each 2–3 point)* 26 kV

1

NA

None, yes

Chen (2009) [62]

Prospective comparative design

17

42.9 ± 9.3

11.3 ± 3.4

Four points with 1 cm apart within the junctional zone were chosen with a metallic pin under C-arm control, and the corresponding locations were marked on the skin in the groin area. The depth of treatment was adjusted until the two ring markers of the device synchronized under C-arm imaging

1500*0.62 each of the four sites

1

NA

None, yes

D’Agostino (2014) [59]

Prospective open design

20

43.23

4.2 (4–7) weeks

NR

4000*0.5

2

2 days

None

Hsu (2010) [63]

RCT

35 (48 hips)

39.6 ± 11.9

7.2 ± 2.9

The hip joint was properly positioned by abduction and internal or external rotation. The junctional zone between avascular and normal bones of the femoral head was delineated with C-arm imaging

1500*0.62 each of the four sites

1

NA

None, yes

Ludwig (2001) [64]

Prospective open design

22

54.9 ± 12.3

NR

NR

4000*0.62

1

NA

None

Vulpiani (2012) [60]

Prospective open design

36

Stage I: 49.3 ± 11.9

Stage II: 52.7 ± 14.6

Stage III: 45.9 ± 14.1

Stage I: 4.3 ± 2.4

Stage II: 9.3 ± 4.6

Stage III: 14.7 ± 5.9

SWT was focused around (on the margins of) the necrotic bone of the femoral head under radiographic guidance

2400*5

4

2–3 days

None

Wang (2016) [65]

RCT

33 (42 hips)

41.8 ± 9.1

9.3 ± 8.4

Both legs were properly positioned. Under C-arm and MRI guidance, the junctional zone between normal bone and necrotic bone within the femoral head was delineated. Within the junctional zone, four points approximately 1 cm apart were chosen under C-arm imaging control and the corresponding locations were marked on the skin in the groin area

Group A: 2000*0.51

Group B: 4000*0.51

Group C: 6000*0.51

1

NA

None, Yes

Wang (2012) [66]

Prospective comparative design

23 (29 hips)

NR

NR

NR

6000*0.474

1

NA

None

Wang (2009) [67]

Prospective comparative design

Total 39, 15(26 hips) with SLE, 24(29 hips) controls

SLE group: 32.33 ± 8.97

Non-SLE group: 36.47 ± 8.95

SLE group: 6.88 ± 2.63

Non-SLE group: 7.1 ± 2.79

Four points with 1 cm apart within the junctional zone were chosen with a metallic pin under C-arm control, and the corresponding locations were marked on the skin in the groin area. The depth of treatment was adjusted until the two ring markers of the device synchronized under C-arm imaging

1500*0.62 each of the four sites

1

NA

None, yes

Wang (2005) [68]

RCT

23(29 hips)

39.8 ± 12.1

5.9 ± 4.5

SWT was applied in the supine position. The hip was positioned in adduction and internal rotation. In patients with a stage-II or III lesion, the junctional zone between avascular and vascular bone of the femoral head was delineated under c-arm control. Four focal points 1 cm apart, within the junctional zone were selected, and the corresponding locations on the skin in the groin area were marked. In patients with a stage-I lesion, the junctional zone was selected on the basis of findings on MRI

1500*0.62 each of the four sites

1

NA

None, Yes

Wang (2008) [69]

RCT

25 (30 hips)

38.6 ± 12.6

7.5 ± 3

The junctional zone between the avascular and normal bones of the femoral head was delineated with C-arm imaging. Four points with 1 cm apart within the junctional zone were chosen with a metallic pin under C-arm control, and the corresponding locations were marked on skin in the groin

1500*0.62 each of the four sites

1

NA

None, yes

Wang (2011) [70]

Prospective open design

35 (47 hips)

38.8 ± 11.9

7.4 ± 3

The hip joint was properly positioned by adduction and internal or external rotation. Four points with 1 cm apart within the junctional zone were chosen with a metallic pin under C-arm control, and the corresponding locations were marked on the skin in the groin area. The depth of treatment was adjusted until the two ring markers of the device synchronized under C-arm imaging

1500*0.62 each of the four sites

1

NA

None, yes

  1. NR not reported, NA not applicable