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The effects of shockwave on systemic concentrations of nitric oxide level, angiogenesis and osteogenesis factors in hip necrosis

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Abstract

This study investigated the effects of shockwave on systemic concentrations of nitric oxide (NO) level, angiogenic and osteogenic and anti-inflammatory factors in hips with osteonecrosis of the femoral head (ONFH). Thirty-five patients (47 hips) with ONFH were enrolled in this study. Each hip was treated with 6,000 impulses of shockwave at 28 kV in a single session. Ten milliliters of peripheral blood was obtained for the measurements of serum NO level, angiogenic factors (VEGF, vWF, FGF basic and TGF-β1); osteogenic factors (BMP-2, osteocalcin, alkaline phosphatase, DKK-1 and IGF); and anti-inflammation markers (sICAM and sVCAM) before treatment and at 1, 3, 6 and 12 months after treatment. The hips were evaluated with clinical assessment, serial radiograph and MRI. At 12 months, the overall results showed 83% improved and 17% un-improved. Total hip was performed in 4 cases (8.5%). Serum NO3 level showed significant elevation at 1 month after treatment, but the changes at 3, 6 and 12 months were not significant. For angiogenesis, significant elevations of VEGF, vWF and FGF basic and a decrease in TGF-β1 were observed at 1 month, but the changes at 3, 6 and 12 months were non-significant. For osteogenesis, BMP-2, osteocalcin, alkaline phosphatase and IGF were significantly elevated, while DKK-1 was decreased at 1 month, but the changes at 3, 6 and 12 months were not significant. For anti-inflammation markers, significant decreases in sICAM and sVCAM were noted at 1 month after treatment, but the changes at 3, 6 and 12 months were non-significant. Local ESWT application results in significant elevations of serum NO level, angiogenic and osteogenic and anti-inflammatory factors in ONFH.

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Acknowledgments

Funds were received in total or partial support for the research or clinical study presented in this article. The funding sources were from National Health Research Institute (NHRI-EX96-9423EP) and Chang Gung Research Fund (CMRPG840531, CMRPG840532, CMRPG840533).

Conflict of interest statement

The authors declared that they did not receive any honoraria or consultancy fees in writing this manuscript. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. One author (CJW) has served as a member of the scientific committee of Sanuwave, Alpharetta, GA.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Chang Gung University College of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, 123 Ta-Pei Road, Niao Sung Hsiang, Kaohsiung, 833, Taiwan

    Ching-Jen Wang

  2. Department of Medical Research, Chang Gung University College of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan

    Ya-Ju Yang

  3. Department of Radiology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan

    Chung-Cheng Huang

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  1. Ching-Jen Wang
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  2. Ya-Ju Yang
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Correspondence to Ching-Jen Wang.

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Wang, CJ., Yang, YJ. & Huang, CC. The effects of shockwave on systemic concentrations of nitric oxide level, angiogenesis and osteogenesis factors in hip necrosis. Rheumatol Int 31, 871–877 (2011). https://doi.org/10.1007/s00296-010-1384-7

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  • DOI: https://doi.org/10.1007/s00296-010-1384-7

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