Application of extracorporeal shock wave lithotripter (ECSWL) in orthopaedics. III. In vitro and in vivo studies.

The present study was conducted to compare the push-out strength of the treated and control samples obtained after implantation of intramedullary rod in canine femurs with bone cement to simulate the femoral stem implantation for 2 weeks, 3 and 6 months. Contralateral femur served as control. The result showed a significant decrease in push-out interfacial strength after shock wave treatment (average 48.4% decrease compared with control, p less than 0.0001) which is similar to the in vitro results. There was no significant difference if the shock treatment was applied and left for 2 weeks or 4 weeks compared to the ones tested immediately after sacrifice. There were some soft tissue damage immediately following shock treatment in the focal area but this returned to normal in 2 weeks. Human cadaveric femoral bone experiment results showed that results are similar for both human cadaveric femoral bones and the canine bone (the dosage level was higher for the human bone than canine). The number of impacts used to extract the bone cement plug out of a human femur segment (5-cm long) decreased about 68% at 23 and 25 kV treatment power level. These preliminary studies indicate that the shock wave can be utilized to reduce the interfacial strength of the bone and bone cement although more studies are needed to assess its efficacy in terms of cost, long-term effect on patients and the exact mechanism of the loosening before this technique can be used clinically.