Chinese herbal medicine formulas as adjuvant therapy for osteonecrosis of the femoral head

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Abstract

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Abstract

Background:

Osteonecrosis of femoral head (ONFH) is a disabling clinical entity affecting mainly young adults. Although Chinese Herbal Medicine (CHM) has been widely used as an adjunct therapy for ONFH in China, its effectiveness is not well defined. The purpose of this systematic review is to assess the effectiveness of CHM as an adjunct therapy to core decompression (CD) for patients with ONFH.

Methods:

A systematic literature search was conducted in 10 electronic databases. Randomized controlled trials involving CHM and CD for ONFH were included. Two authors independently assessed the studies for inclusion and extracted the data. A meta-analysis was conducted to estimate the safety and efficacy of CHM as an adjunct therapy.

Results:

Twenty-three randomized controlled trials with 1815 participants were included. The formulas used in these studies were different and we only combined data of studies observing the same formulas. Patients treated with CHM additionally exhibited a better TER (total effective rate) compared with CD alone in different degree, with the risk ratio (RR) varies from 1.09 to 1.09. The Harris score and radiographic effective rate indicate a similar result, with the medicine (MD) varies from 17.35 to 14.94 and RR 1.40 to 1.27. The risk of side-effect was barely reported except only 2 study record that no complications were observed.

Conclusion:

This systematic review indicated that CHM as adjunctive therapy may improve the effectiveness of CD. However, a firm conclusion could not be reached because of overall high risk of bias in most domains. Further studies of higher quality are required, and other benefits of CHM remain to be determined.

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Most cited references 47

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Osteonecrosis of the femoral head: etiology, imaging and treatment.

Konstantinos N. Malizos, Apostolos H Karantanas, Konstantinos Bargiotas … (2007)

Osteonecrosis of the femoral head is a disabling clinical entity affecting young adults that usually leads to destruction of the hip joint. A high index of suspicion is necessary for the diagnosis due to the insidious onset of the bone infarcts and the lack of specific clinical signs at the early stages. Many etiology-associated factors have been identified reducing thus the number of idiopathic cases. A number of joint salvaging treatment options are available if early diagnosis can be achieved. MR imaging has been proved to be a highly accurate method both for early diagnosis and for staging of the disease. Replacement of the hip joint is the last resort for pain relief and function, although non-desirable because of the young age of the affected population.

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Do modern techniques improve core decompression outcomes for hip osteonecrosis?

David Marker, Siddharth Srivastava, Thorsten M Seyler … (2008)

Core decompression procedures have been used in osteonecrosis of the femoral head to attempt to delay the joint destruction that may necessitate hip arthroplasty. The efficacy of core decompressions has been variable with many variations of technique described. To determine whether the efficacy of this procedure has improved during the last 15 years using modern techniques, we compared recently reported radiographic and clinical success rates to results of surgeries performed before 1992. Additionally, we evaluated the outcomes of our cohort of 52 patients (79 hips) who were treated with multiple small-diameter drillings. There was a decrease in the proportion of patients undergoing additional surgeries and an increase in radiographic success when comparing pre-1992 results to patients treated in the last 15 years. However, there were fewer Stage III hips in the more recent reports, suggesting that patient selection was an important reason for this improvement. The results of the small-diameter drilling cohort were similar to other recent reports. Patients who had small lesions and were Ficat Stage I had the best results with 79% showing no radiographic progression. Our study confirms core decompression is a safe and effective procedure for treating early stage femoral head osteonecrosis.

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Systematic analysis of classification systems for osteonecrosis of the femoral head.

Elizabeth E. Steinberg, Michael Mont, German A Marulanda … (2006)

Multiple classification systems for osteonecrosis of the hip have been developed to assist physicians in the diagnosis and treatment of this potentially debilitating disorder. The purpose of this analysis was to delineate the classification systems utilized in reports published since 1985 and, through a comparison of the most commonly used systems, to identify consistent factors that would allow for cross-publication comparisons to be made. We performed a PubMed search for reports of outcome studies concerning treatment methods for osteonecrosis of the hip. All studies of reported outcomes with greater than ten patients were included in the analysis. Various classification systems were tabulated to determine usage frequencies. The four most commonly used systems were then analyzed to determine common factors used for classification. One hundred and fifty-seven studies were available for analysis. Sixteen major classification systems that made use of more than one radiographic factor were identified, and nine of these systems had one to five modifications reported throughout the literature. Additionally, eleven other systems made use of single factors obtained from either magnetic resonance imaging or anatomic data. The review revealed that four classification systems accounted for greater than 85.4% of the reported studies. Parameters for these four systems were stratified to allow for uniformity of patient or study evaluation. This analysis of the reported classification systems for osteonecrosis of the femoral head revealed several similarities between the most commonly used systems. An analysis of patients can be made with any of the four major systems if specific data are collected according to various magnetic resonance imaging and radiographic findings. This approach will allow for easier comparison of studies across different centers. Prognostic Level III. See Instructions to Authors on jbjs.org for a complete description of levels of evidence.

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Author and article information

Journal

Journal ID (nlm-ta): Medicine (Baltimore)

Journal ID (iso-abbrev): Medicine (Baltimore)

Journal ID (publisher-id): MEDI

Title: Medicine

Publisher: Wolters Kluwer Health

ISSN (Print): 0025-7974

ISSN (Electronic): 1536-5964

Publication date Collection: September 2018

Publication date (Electronic): 07 September 2018

Volume: 97

Issue: 36

Electronic Location Identifier: e12196

Affiliations

[a ]First Affiliated Hospital

[b ]First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong

[c ]Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China.

Author notes

[∗ ]Correspondence: Peng Chen, First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510405, China (e-mail: docchen777@ 123456gmail.com ), Wei He, First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510405, China (e-mail: hw13802516062@ 123456126.com ).

Article

Publisher ID: MD-D-17-03414 Accession ID: 12196

DOI: 10.1097/MD.0000000000012196

PMC ID: 6133442

PubMed ID: 30200126

SO-VID: 9e92271e-1104-4427-bb16-3c99250d9959

License:

This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

History

Date received : 1 June 2017

Date accepted : 9 August 2018

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Keywords: adjuvant therapy,chinese herbal medicine formulas,meta-analysis,osteonecrosis of the femoral head,prisma—driven systematic review

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Keywords: adjuvant therapy, chinese herbal medicine formulas, meta-analysis, osteonecrosis of the femoral head, prisma—driven systematic review

Chinese herbal medicine formulas as adjuvant therapy for osteonecrosis of the femoral head : A systematic review and meta-analysis of randomized controlled trials

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Most cited references 47

Osteonecrosis of the femoral head: etiology, imaging and treatment.

Do modern techniques improve core decompression outcomes for hip osteonecrosis?

Systematic analysis of classification systems for osteonecrosis of the femoral head.

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