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 |