Comparative Effectiveness of Focused Extracorporeal versus Radial Extracorporeal Shockwave Therapy for Knee Osteoarthritis—Randomized Controlled Study

Abstract

Both focused extracorporeal shockwave (f-ESWT) and radial extracorporeal shockwave therapy (r-ESWT) can alleviate symptoms in patients with knee osteoarthritis, but no trials have directly compared f-ESWT with r-ESWT for knee osteoarthritis. This study aimed to compare the effectiveness of f-ESWT and r-ESWT on knee osteoarthritis. Forty-two patients with bilateral knee osteoarthritis were randomly assigned to receive three sessions of either f-ESWT or r-ESWT at 1-week intervals. The patients were evaluated at baseline and at 4 and 8 weeks after the final treatment. The primary outcome was the change in pain intensity, as measured on the visual analog scale (VAS). Secondary outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), range of motion of the knee joint, and the 6-minute walk test. At the end of 4 weeks, the VAS score was substantially reduced in both groups (f-ESWT, −4.5 ± 2.5 points; r-ESWT, −2.6 ± 2.0 points), with a greater reduction in the f-ESWT group. Both groups showed significant improvement in secondary outcomes; however, the f-ESWT group yielded greater improvement in the VAS score, WOMAC score, and 6-minute walk test. Our results showed that f-ESWT was more effective than r-ESWT in improving pain and physical function in patients with knee osteoarthritis.

The Short-Term Efficacy of Large-Focused and Controlled-Unfocused (Radial) Extracorporeal Shock Wave Therapies in the Treatment of Hip Osteoarthritis

“…From the first article in 2013 [ 30 ] to date, previous studies on the treatment of OA with ESWT have mostly focused on knee OA [ 21 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ].…”

“…Although the shock and frequency values were the same in both groups, it was stated that f-ESWT was applied with 0.10 mj/mm 2 energy and r-ESWT was applied with 3.0 bar pressure. Pain and physical function status assessed by VAS, WOMAC, and the 6 minute walk test in the 4th and 8th week of post-treatment controls improved significantly more in the f-ESWT group compared to the r-ESWT [ 21 ].…”

“…However, treatment of knee OA, which is a large joint of the lower extremity similar to the hip joint, with ESWT may constitute a more accurate model for our study. In the studies on the treatment of knee OA with ESWT [ 21 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ], more positive treatment responses were obtained with higher energy and pressure values. However, the high level of energy might have affected the treatment results more positively than the high level of pressure [ 21 ].…”

“…In the studies on the treatment of knee OA with ESWT [ 21 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ], more positive treatment responses were obtained with higher energy and pressure values. However, the high level of energy might have affected the treatment results more positively than the high level of pressure [ 21 ]. The reality that f-ESWT was found to be more effective in our study may be related to the fact that the energy level reached 0.60 mj/mm 2 and the pressure value reached 1.8 bar in certain sequences of the session.…”

“…Of the 14 studies, 5 used f-ESWT, 8 used r-ESWT, and 1 used both, but none were “ESWT type comparison” studies [ 20 ]. In a very recent study comparing f-ESWT and r-ESWT in the treatment of knee OA, although both were observed to be effective, f-ESWT was superior to r-ESWT in reducing pain and improving function [ 21 ].…”