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The osteonecrosis of femoral head (ONFH) has been a common disorder in clinical orthopaedic practice. ONFH is the relative contraindication of hip arthroplasty for the young and active patients since they suffer a high rate of revision and inferior function postoperatively. The primary importance in therapy is to prevent the progression of the disease and the collapse of the articular surface in order to keep away from hip arthroplasty. Low-intensity pulsed ultrasound (LIPUS) has been indicated to enhance the osteogenic differentiation of mesenchymal stem cells, stimulate the differentiation and the proliferation of osteoblasts, inhibit osteoclasts, improve the local blood perfusion and the angiogenesis, and accelerate the healing process of the stress fracture. We present a hypothesis that LIPUS may be an appropriate non-invasive modality for bone repair in the early stage of ONFH so that the progressive collapse of the articular surface and the subsequent arthroplasty would be avoided.

Rhizoma drynariae is used commonly in the treatment of osteoporosis and bone nonunion in traditional Chinese medicine. Modern pharmacological research indicates that naringin is the main effective component of rhizoma drynariae, which can induce the expression of the osteogenic marker in the osteoblast cell line. However, no former study has described its effect on bone mesenchymal stem cells (BMSCs). In our experiment, we co-cultured human BMSCs with different concentrations of naringin solution, then the osteogenic differentiation markers and proliferation ability were analyzed. The results indicated that a certain concentration (1–100 μg/ml) of the naringin solution may enhance the proliferation and osteogenic differentiation of human BMSCs. Also, our research explains excellently the anti-osteoporotic and bone nonunion treatment mechanism of rhizoma drynariae, thus contributing to the exploration of osteogenic differentiation agents from Chinese herbs.

Though it is well accepted that low-intensity pulsed ultrasound (LIPUS) can accelerate the healing process of a fracture with very good results, we should still pay attention to its side effects and further improve its application in detail, such as the appropriate time and point for the application. In the early phase of a bone fracture, there are millions of oxygen radicals released by neutrophils in the injured area. This article focuses on whether the increased permeability of normal cell membranes by LIPUS makes the concentration of oxygen radicals increase to such a high degree that damage occurs to healthy tissue cells. It is proposed that it may be better not to use LIPUS in the acute phase of a fracture (i.e. within 1week after injury) but instead delay its application until after any inflammatory reaction has weakened to yield better results.