Cocktail therapy for hip necrosis in SARS patients

Background: There are no treatment guidelines for hip necrosis in severe acute respiratory syndrome (SARS) patients. A new regimen of cocktail therapy that consists of extracorporeal shockwave therapy (ESWT), hyperbaric oxygen therapy (HBO) and oral alendronate was utilized in four patients with eight hips. This study evaluated the outcomes of cocktail therapy with a 4-year follow-up. Methods: There were 3 women and 1 man with an average age of 26 ± 3.8 years. Each hip was treated with 6000 impulses of ESWT at 0.62 mJ /mm² energy flux density in a single session. Each patient received HBO treatment for 100 sessions and oral alendronate for one year. The evaluations included pain score and Harris hip score, radiographs and magnetic resonance imaging (MRI) of the affected hips. Results: At the 4-year follow-up, significant improvements in pain score and Harris hip score were observed in all cases (p < 0.001). All patients returned to work as healthcare providers. None required surgical intervention including hip replacement. MRI showed a trend of reduction in bone marrow edema and the size of the lesion, but no changes in the stage of the lesion. Conclusion: Cocktail therapy seems promising in delaying the disease progression of SARS-associated femoral head necrosis in the short-term.