Nonpharmacological, nonsurgical interventions for nontraumatic osteonecrosis
| Treatment . | Indication . | Study cohort . | Dose . | Study design . | ON classification . | Follow-up . | Conclusions . | Reference . |
|---|---|---|---|---|---|---|---|---|
| HBO | ON ALL/ NHL | 19 pts (0, 7-15, 6 y) | 13-80 treatments | Single center | Number of lesions (MRI) | 12 mo | Pain reduction | 52 |
| ESWT | >30 y and ARCO I-III | 19 pts (30 hips) | A (1000 shocks/session, EFD per shock 0.12 mJ/mm2) | Single center | ARCO | 6 mo | VAS, Harris Hip Score, and Osteoarthritis Index improved | 53 |
| B (1000 shocks/ session, EFD per shock 0.32 mJ/mm2) | ||||||||
| ESWT | n.s. | 40 pts (31.9-54 y) | Group A, group B: prostacyclin and bisphosphonate | Single center, prospective, randomized | Bone marrow edema | >12 mo | Improvement in pain and function of affected knees; complete regression in all pts of group A | 59 |
| (S)PEMF | In vitro cell culture, in vivo mice | 2 humans/ 18 mice | Mice: 1 Tesla, 30 pulses/d | Single center | Mice: histopathology | 4 wk | Bone repair, neovascularization, and cell growth in necrotic bone in mice | 57 |
| Treatment . | Indication . | Study cohort . | Dose . | Study design . | ON classification . | Follow-up . | Conclusions . | Reference . |
|---|---|---|---|---|---|---|---|---|
| HBO | ON ALL/ NHL | 19 pts (0, 7-15, 6 y) | 13-80 treatments | Single center | Number of lesions (MRI) | 12 mo | Pain reduction | 52 |
| ESWT | >30 y and ARCO I-III | 19 pts (30 hips) | A (1000 shocks/session, EFD per shock 0.12 mJ/mm2) | Single center | ARCO | 6 mo | VAS, Harris Hip Score, and Osteoarthritis Index improved | 53 |
| B (1000 shocks/ session, EFD per shock 0.32 mJ/mm2) | ||||||||
| ESWT | n.s. | 40 pts (31.9-54 y) | Group A, group B: prostacyclin and bisphosphonate | Single center, prospective, randomized | Bone marrow edema | >12 mo | Improvement in pain and function of affected knees; complete regression in all pts of group A | 59 |
| (S)PEMF | In vitro cell culture, in vivo mice | 2 humans/ 18 mice | Mice: 1 Tesla, 30 pulses/d | Single center | Mice: histopathology | 4 wk | Bone repair, neovascularization, and cell growth in necrotic bone in mice | 57 |
ARCO, association research circulation osseous; EFD, energy flux density; HBO, hyperbaric oxygenation; ESWT, extracorporeal shock wave therapy; HSCT, hematopoietic stem cell transplantation; NHL, non-Hodgkin lymphoma; n.s., not specified; (S)PEMF, (single) pulsed electromagnetic fields; VAS, visual analog scale