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Peer review report 3 on “Dosage Effects of Extracorporeal Shockwave Therapy in Early Hip Necrosis”
International Journal of Surgery 37 Supplement 1 (2017) S90
Contents lists available at ScienceDirect
International Journal of Surgery journal homepage: www.journal-surgery.net
Peer review report
Peer review report 3 on “Dosage Effects of Extracorporeal Shockwave Therapy in Early Hip Necrosis”
1. Original submission 1.1. Recommendation Minor Revision 1.2. Comments to the author This paper describes the dose dependent effects of extracorporeal shockwave therapy on necrosis of the femoral head (ARCO I IIIa). The authors evaluated efficacy by applying various parameter including clinical, imaging and biomolecular measures. They found significant improvement in pain in group C in comparison to group A over the entire observation period. Interestingly the Harris hip score was only significant better 6 months after treatment between the mentioned groups. Analyzing the different biomolecular parameter they could also find significant better serum levels in favour to ESWT with a higher number of impulses. This manuscript is interesting and of high interest to provide patients an effective and non-invasive treatment modality in the indication of osteonecrosis of the femoral head. However some issues have to be addressed before this paper can be considered for publication: Why this prospective study was planned without a control group reflecting the standard of care treatment (i.e. core decompression)? It would have been interesting to compare ESWT with standard of care to evaluate and show the positive effects of the treatment (e.g. non-invasive, faster rehabilitation, etc) What is the explantation of the authors that the pain decreased but not the Harris hip score improved over the observation time period? Did the authors performed ESWT at the various parameter (e.g. group A on one hip and group C on the other hip) in patients who
DOI of published article: http://dx.doi.org/10.1016/j.ijsu.2016.09.013. http://dx.doi.org/10.1016/j.ijsu.2016.12.110 1743-9191
suffered from bilateral ONFH, or did they perform the same parameter in those patients? If this is true that different treatments were realized in these patients, how can the authors discriminate between the influence of the treatment on one side and the other side, especially regarding the results of the biomolecular analysis showing a systemic effect. Did the 4 patients in group A received arthroplasty due to pain or progression of femoral head necrosis? How MRI guidance was performed before the treatment? The results given in the specific section are not congruent with the figures (eg NO3 - more significant differences are given in the text as compared to the figure) The figure legend are incomplete; the authors should give more details about the numbers, significant levels,… Would it be possible that the patients in group A had a worser outcome due to the fact that in this group 6 bilateral hips were included? Could it be due to the inability to partially weight bear in this patients? How the authors comment on the fact that group A had a worser baseline on the demopraphics not only in the ARCO stage (5 hips with ARCO III vs 3 in group B and 2 in group C) but also in the age, etc. How did the authors performed the randomization? It seems that the parameter pain at 24 months did not differ significantly between groub B and C as stated in the text. The discussion is not sufficient; it is not enough to give the results another time. The results should be discussed in more detail with the recent literature. The manuscript should be also carefully revised with respect to typos, grammar mistakes and icongruency Anonymous reviewer
Contents lists available at ScienceDirect
International Journal of Surgery journal homepage: www.journal-surgery.net
Peer review report
Peer review report 3 on “Dosage Effects of Extracorporeal Shockwave Therapy in Early Hip Necrosis”
1. Original submission 1.1. Recommendation Minor Revision 1.2. Comments to the author This paper describes the dose dependent effects of extracorporeal shockwave therapy on necrosis of the femoral head (ARCO I IIIa). The authors evaluated efficacy by applying various parameter including clinical, imaging and biomolecular measures. They found significant improvement in pain in group C in comparison to group A over the entire observation period. Interestingly the Harris hip score was only significant better 6 months after treatment between the mentioned groups. Analyzing the different biomolecular parameter they could also find significant better serum levels in favour to ESWT with a higher number of impulses. This manuscript is interesting and of high interest to provide patients an effective and non-invasive treatment modality in the indication of osteonecrosis of the femoral head. However some issues have to be addressed before this paper can be considered for publication: Why this prospective study was planned without a control group reflecting the standard of care treatment (i.e. core decompression)? It would have been interesting to compare ESWT with standard of care to evaluate and show the positive effects of the treatment (e.g. non-invasive, faster rehabilitation, etc) What is the explantation of the authors that the pain decreased but not the Harris hip score improved over the observation time period? Did the authors performed ESWT at the various parameter (e.g. group A on one hip and group C on the other hip) in patients who
DOI of published article: http://dx.doi.org/10.1016/j.ijsu.2016.09.013. http://dx.doi.org/10.1016/j.ijsu.2016.12.110 1743-9191
suffered from bilateral ONFH, or did they perform the same parameter in those patients? If this is true that different treatments were realized in these patients, how can the authors discriminate between the influence of the treatment on one side and the other side, especially regarding the results of the biomolecular analysis showing a systemic effect. Did the 4 patients in group A received arthroplasty due to pain or progression of femoral head necrosis? How MRI guidance was performed before the treatment? The results given in the specific section are not congruent with the figures (eg NO3 - more significant differences are given in the text as compared to the figure) The figure legend are incomplete; the authors should give more details about the numbers, significant levels,… Would it be possible that the patients in group A had a worser outcome due to the fact that in this group 6 bilateral hips were included? Could it be due to the inability to partially weight bear in this patients? How the authors comment on the fact that group A had a worser baseline on the demopraphics not only in the ARCO stage (5 hips with ARCO III vs 3 in group B and 2 in group C) but also in the age, etc. How did the authors performed the randomization? It seems that the parameter pain at 24 months did not differ significantly between groub B and C as stated in the text. The discussion is not sufficient; it is not enough to give the results another time. The results should be discussed in more detail with the recent literature. The manuscript should be also carefully revised with respect to typos, grammar mistakes and icongruency Anonymous reviewer