Background: Knee osteoarthritis (OA) is the most common form of degenerative arthritis. It causes difficulty in activities of daily living. Generally, intra-articular injection of hyaluronic acid is widely used for knee OA treatment. Recently, many researchers have demonstrated the effects of focused extracorporeal shock wave therapy (fESWT) on knee OA. There are several researches that have reported the mechanisms and effects of fESWT on knee OA. But, there are no research synergic effect of fESWT with intra-articular injection for knee OA treatment. The aim of this study is to compare the effect of intra articular injections of HA plus fESWT and that of intra-articular injections of HA only in knee OA patients.
Method: We enrolled patients who were confirmed as knee OA by radiological examination. We excluded patients with illness of neurologic disease, cardiac disorders, physical function. All patients were randomly assigned to the HA plus fESWT (HAE) group or the HA only group (HA). The fESWT probe was targeted on the medio-tibial subchondral area. The probe was oriented perpendicular to the area, and ultrasound gel was used as a coupling agent. Both group received injection of 3ml HA 1time. The HAE group received a session of fESWT that comprised 2000 impulses of shock wave a week for 3 weeks. Energy level was 0.05 mJ/mm2. Before the first intervention and after the last intervention, patients were evaluated using visual analogue scale (VAS), Western Ontario and McMaster Universities arthritis index (WOMAC), Lequesne index (LI), Stair-climb test (SCT) and Isokinetic knee extensor (peak torque 60°, 120°).
Results: Nine patients were recruited in each group. There were no significant differences in the baseline characteristics and initial measurements between two groups (Table 1). After the treatment, improvement was found in all the measurement items in both groups. However, statistically significant improvement was found in VAS, WOMAC, Lequesne index and SCT in the both group. When changes of measurement were compared between two groups, there was significant improvement in WOMAC and Lequesne index at HAE group. (Table 3).
Conclusion: HA plus fESWT resulted in better functional improvement of knee OA than HA treatment only. Therefore, the fESWT could be used as an additional treatment of knee OA. Future studies with a larger number of participants should be necessary.
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