Comparison of Extracorporeal Shockwave Therapy with Non-Steroid Anti-Inflammatory Drugs and Intra-Articular Hyaluronic Acid Injection for Early Osteoarthritis of the Knees

Shun-Wun Jhan, Ching-Jen Wang, Kuan-Ting Wu, Ka-Kit Siu, Jih-Yang Ko, Wen-Chiung Huang, Wen-Yi Chou, Jai-Hong Cheng • Biomedicines • 2022 • Focused ESWT

Summary

This randomized clinical trial compared ESWT with NSAIDs and intra-articular hyaluronic acid (HA) injection for early knee osteoarthritis. The study found that ESWT provided better pain relief and functional improvement than both NSAIDs and HA, with significant increases in bone mineral density of the proximal tibia. All three treatments showed improvements, but ESWT demonstrated superior and more durable results over the one-year follow-up period.

Key Findings

"ESWT was superior in pain relief than HA (p = 0.015) and NSAIDs (p = 0.015) groups."

"The functional score improvement in KOOS and WOMAC scores after treatment was better in ESWT group, comparing with NSAIDs and HA groups (p < 0.05)"

"The BMD significantly increased in proximal tibia only after ESWT treatment (p = 0.004)."

"ESWT group prevented the increasing of COMP in the patient with knee OA after one-year follow-up treatment."

"The results demonstrated that ESWT was an effective and alternative therapy than HA and NSAIDs for early osteoarthritis of the knees."

Treatment Categories

Early Knee Osteoarthritis

high effectiveness

ESWT showed significant improvements in pain relief and functional scores compared to NSAIDs and HA injection for early knee OA (Kellgren-Lawrence grade I and II). ESWT also increased bone mineral density in the proximal tibia, suggesting a potential disease-modifying effect.

Specific Findings

ESWT provides superior pain relief compared to NSAIDs and HA injection

Randomized clinical trial with 45 patients (50 knees) followed for one year

Patient Type

General Population with early knee OA (Kellgren-Lawrence grade I and II)

Shockwave Type

Focused ESWT

Protocol

sessions: 3 sessions

energyFluxDensity: 0.22 mJ/mm2

impulses: 3000 impulses per session

frequency: Bi-weekly interval

Outcomes

Pain Reduction: Significant VAS score improvement continuing for one year, superior to NSAIDs and HA (p=0.015)

Functional Improvement: Significant improvements in KOOS, WOMAC, and IKDC scores, better than NSAIDs and HA groups (p<0.05)

Tissue Healing: Increased bone mineral density in proximal tibia (p=0.004)

Return to Activity: Improved functional scores suggesting better activity levels

Compared To: NSAIDs (celecoxib 200mg daily for 3 weeks) and HA injection (weekly for 3 weeks)

Limitations

Relatively small sample size, short radiographic evaluation period (one year), potential biases in inter-observer evaluation

Study Limitations

Sample sizes are relatively small even though they meet statistical requirements
One-year follow-up period may not be long enough to evaluate radiographic changes
Potential biases in inter-observer evaluation
MRI sensitivity not as good as expected for assessment of OA changes
Patient compliance with oral NSAIDs administration required stringent study protocol

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