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. 2024 Aug 21:15:1428125.
doi: 10.3389/fendo.2024.1428125. eCollection 2024.

Effectiveness of various interventions for non-traumatic osteonecrosis: a pairwise and network meta-analysis

Shaoyang Zhai  1 , Rui Wu  1 , Jie Zhao  1 , Wang Huang  1 , Weiwei Hu  1 , Weichen Huang  2
Affiliations

Effectiveness of various interventions for non-traumatic osteonecrosis: a pairwise and network meta-analysis

Shaoyang Zhai et al. Front Endocrinol (Lausanne). .

Abstract

Background: Osteonecrosis of the femoral head (ONFH) is acknowledged as a prevalent, challenging orthopedic condition for patients.

Purpose: This study aimed to evaluate the efficacy of various interventions for non-traumatic ONFH and provide guidance for clinical decision-makers.

Methods: We searched PubMed, Embase, Cochrane Library, and Web of Science databases from inception to February 2023 for relevant randomized controlled trials evaluating treatments for femoral head necrosis, without language restrictions. Quality evaluation was performed using the Cochrane risk-of-bias assessment tool, and analysis was performed using Stata 15.1.

Results: Eleven randomized controlled trials were included in this study. The meta-analysis results revealed that CellTherapy [MD= -3.46, 95%CI= (-5.06, -1.85)], InjectableMed [MD= -3.68, 95%CI= (-6.11, -1.21)], ESWT [MD= -2.84, 95%CI= (-4.23, -1.45)], ESWT+InjectableMed [MD= -3.86, 95%CI= (-6.22, -1.53)] were significantly more effective in improving VAS pain score than CD+PTRI, as well as CD+BG+CellTherapy, and CD+BG. Furthermore, CD+BG+CellTherapy was better than CD+BG [MD= -0.97, 95%CI= (-1.71, -0.19)]. The SUCRA ranking for HHS score indicated that CellTherapy (77%) has the best effectiveness rate, followed by ESWT+InjectableMed (72.2%), ESWT (58.3%), InjectableMed (50%), CD+PTRI (31.4%), and CD+BG (11%). In terms of WOMAC and Lequesne scores, the meta-analysis showed no statistically significant differences between the experimental group CD+BG+CellTherapy and the control group CD+BG.

Conclusion: CellTherapy and non-surgical ESWT combined with medication or CellTherapy have the best effect on ONFH. Surgical CD+BG combined with CellTherapy is more effective than CD+BG alone. ESWT+InjectableMed is recommended for short-term or acute onset patients, while ESWT is recommended for long-term patients.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO, identifier CRD42024540122.

Keywords: core decompression (CD); extracorporeal shock wave therapy (ESWT); free vascularized fibular grafting (FVFG); meta-analysis; multiple drilling decompression (MDD); osteonecrosis of the femoral head (ONFH); vascularized or non-vascularized bone grafting surgery/resection (VGF).

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The literature search process.
Figure 2
Figure 2
The bias risk assessment of the included literature. (A) Risk of bias graph; (B) Risk of bias summary.
Figure 3
Figure 3
(A) VAS network plot; (B) VAS network plot short-term effect; (C) VAS network plot long-term effect.
Figure 4
Figure 4
HHS network plot.
Figure 5
Figure 5
(A) The meta-analysis forest map for VAS; (B) The meta-analysis forest map for HHS; (C) The meta-analysis forest map for WOMAC; (D) The meta-analysis forest map for Lequsne.
Figure 6
Figure 6
The funnel plots of (A) VAS and (B) HHS.
See this image and copyright information in PMC

References

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