Effect of Extracorporeal Shockwave Therapy Versus Intra-articular Injections of Hyaluronic Acid for the Treatment of Knee Osteoarthritis

Abstract

Objective: To evaluate and compare the effects and outcomes of extracorporeal shock wave therapy (ESWT) and intra-articular injections of hyaluronic acid (HA) in patients with knee osteoarthritis (OA).

Methods: Of the 78 patients recruited for the study, 61 patients met the inclusion criteria. The enrolled patients were randomly divided into two groups: the ESWT group and the HA group. The ESWT group underwent 3 sessions of 1,000 shockwave pulses performed on the affected knee with the dosage adjusted to 0.05 mJ/mm² energy. The HA group was administered intra-articular HA once a week for 3 weeks with a 1-week interval between each treatment. The results were measured with the visual analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequesne index, 40-m fast-paced walk test, and stair-climb test (SCT). A baseline for each test was measured before treatment and then the effects of the treatments were measured by each test at 1 and 3 months after treatment.

Results: In both groups, the scores of the VAS, WOMAC, Lequesne index, 40-m fast-paced walk test, and SCT were significantly improved in a time-dependent manner (p<0.01). There were no statistically significant differences measured at 1 and 3 months after treatment between the two groups (p>0.05).

Conclusion: The ESWT can be an alternative treatment to reduce pain and improve physical functions in patients with knee OA.

Keywords: High-energy shock waves; Hyaluronic acid; Knee osteoarthritis.

Fig. 1. A flow diagram, showing the treatment process and assessment. ESWT, extracorporeal shock wave therapy; HA, hyaluronic acid.

Fig. 2. The visual analogue scale (VAS) score (A), Western Ontario and McMaster Universities arthritis index (WOMAC) score (B), Lequesne index score (C), 40-m fast-paced walk test score (D), and stair climb test (SCT) score (E) at baseline and 1- and 3-month follow-ups after treatment in the ESWT group and the HA group. These figures show significant improvement for both groups in all treatment outcomes for the entire period (p<0.01 for time effect, p>0.05 for group-time interaction).