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  1. Martin P Schwellnus
  1. University of Cape Town, South Africa

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    Wang C-J, Wang F-S, Ko J-Y, . Rheumatology 2008;47:542–6.


    Extracorporeal shockwave therapy (ECSWT) has shown some promising results in the treatment of a number of chronic musculoskeletal conditions — recently, ECSWT has been suggested for hip necrosis.

    Research question/s:

    Does ECSWT improve angiogenesis and bone remodelling in patients with osteonecrosis of the femoral head (ONFH)?


    Subjects: 14 patients (male = 11) (19–57 years) undergoing total hip arthroplasty for ONFH.

    Experimental procedure: In a non-randomised fashion, two groups (with similar demographics, duration and stage of lesion) were studied: seven subjects who received ECSWT prior to surgery (ECS group; 1500 impulses at 28 kV, 6000 shocks under imaging guidance), and seven subjects not receiving ECSWT (CON group). The femoral heads were investigated with histopathological examination and immunohistochemical analysis for angiogenesis and bone modelling and regeneration.

    Measures of outcome: Histopathological analysis, angiogenesis (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)), bone remodelling and regeneration (proliferation cell nuclear antigen (PCNA), Dickkopf-1 (DKK1) and Winless 3a (Wnt 3)).

    Main finding/s:

    Histopathology: There was significantly more viable bone, less necrotic bone, higher cell concentration and more cell activities (phagocytosis) in the ECS group than in the CON …

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