Hua Chai

Background: The effectiveness of bone marrow mononuclear cells (BMMCs) combined with core decompression (CD) in the treatment of femoral head necrosis is controversial. The purpose of this study was to conduct a meta-analysis and systematic review of the evaluation of BMMCss combined with CD in the treatment of femoral head necrosis and to compare the therapeutic effect of this method with that of CD alone so as to provide a basis for subsequent research and clinical treatment. Methods: We conducted detailed searches across four databases in Embase, PubMed, Web of Science, and the Cochrane Library (up to October 2023), including eight studies with a total of 370 participants and 491 hip cases. This meta-analysis followed the Preferred Reporting Project (PRISMA) guidelines. Review Manager 5.4 was used to summarize and analyze the outcome indicators and the quality and reliability of the MAs were graded against a Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). Results: Eight studies were included in the inclusion criteria. The results of meta-analysis showed that the therapeutic effect of CD combined with BMMC on visual analog scale was better than that of CD alone [mean difference (MD)=−5.32, 95% confidence interval (CI): −9.90, −0.74, P=0.02, I ²=98%], and there was no statistically significant difference between CD combined with BMMC and CD alone in the treatment of Harris hip score (MD=2.73, 95% CI: −2.63, 8.09, P=0.32, I ²=82%). We conducted a sensitivity analysis. The results showed that the CD joint BMMC treatment effect on the Harris hip score is superior to the single CD (MD=5.57, 95% CI: 1.94, 9.20, P=0.003, I ²=0%), both no significant differences in visual analog scale (MD=0.47, 95% CI: −1.74, 0.79, P=0.46, I ²=83%). Conclusion: In this study, we found that CD combined with bone marrow monocyte therapy improved femoral head necrosis better than CD alone.

Background: Extracorporeal shockwave therapy (ESWT) is a traditional noninvasive therapy to treat osteonecrosis of the femur head (ONFH). This systematic review aims to investigate whether ESWT can improve the clinical function of ONFH and whether differences in improvement can be observed in radiographic outcomes. Materials and methods: Two authors independently searched PubMed, Embase, Cochrane Library, and Web of Science for English articles until 21 October 2023. After screening and reading the literature, the two authors independently used corresponding scales to evaluate the quality of the included articles and extracted data. The key data extracted included the Harris Hip Score (HHS), Visual Analog Scale (VAS), changes in lesion size, the change in the Association Research Circulation Osseous (ARCO) stage, and bone marrow edema (BME) stage. Results: Nine articles included 468 males and 248 females. The average age was 43.29 years and the mean follow-up time was 15.19 months. After receiving ESWT, five studies involving 146 hips showed a higher HHS (MD=−33.38; 95% CI: −46.31, −20.45), and the difference was statistically significant ( P P P =0.06; I ² =84%). Two articles showed that the use of ESWT had no significant effect on the change in the ARCO stage (MD=1.11; 95% CI: 0.76–1.62; P =0.60; I ² =0%). Three studies indicated that using ESWT could improve the BME symptom in the early stage of ONFH (MD=4.35; 95% CI: 1.32–14.37; P =0.02; I ² =62%). Conclusion: Based on the current evidence, ESWT shows promise as a therapy to enhance hip function and alleviate pain in the early stage of ONFH. With the advancement of more precise imaging techniques, ESWT can potentially reduce the area affected by ONFH. However, such reduction was not found to be statistically significant at the imaging level. Additionally, ESWT could improve symptoms of BME in the early stage. However, no significant change in ARCO grade was observed with ESWT treatment.