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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