Abstract
Conservative treatments for early osteoarthritis (OA) of the knee included the use of non-steroid anti-inflammatory drugs (NSAIDs) and intra-articular hyaluronic acid (HA) injection. Recently, several animal studies reported that extracorporeal shockwave therapy (ESWT) demonstrated chondroprotective effects on knee OA. The present study compared the efficacy of oral NSAIDs, HA injection, and noninvasive ESWT for early OA of the knee. Forty-five patients with early knee OA were randomized into three groups. NSAIDs group received celecoxib 200 mg daily for 3 weeks. HA group received intra-articular injection of HA once a week for 3 weeks. ESWT group received ESWT for 3 sessions at bi-weekly interval. All patients were followed up for one year. Evaluations included the visual analogue scale (VAS) score, serum enzyme-linked immunosorbent assay (ELISA), plain radiography, dual-energy X-ray absorptiometry (DEXA), and magnetic resonance imaging (MRI). In addition, the functional scores were performed including, WOMAC (Western Ontario and McMaster Universities Arthritis Index) score, KOOS (knee injury and osteoarthritis outcome) score, and IKDC (International Knee Documentation Committee) score. All three groups showed significant improvement in VAS and functional scores as well as in the collected one-year follow-up data after treatments. ESWT group had better pain relief than NSAIDs and HA groups. ESWT group had better therapeutic effects in the functional scores than NSAIDs and HA groups. The bone mineral density (BMD) of proximal tibia is significantly increased after ESWT than others. In the serum ELISA, ESWT inhibited the expression of COMP in knee OA patients as compared with NSAIDs and HA groups. The parameters of MRI showed no significant differences between three groups after treatments. ESWT and intra-articular HA injection showed comparable results than NSAIDs. ESWT was superior in pain relief than HA and NSAIDs. The results demonstrated that ESWT was an effective and alternative therapy than HA and NSAIDs for early osteoarthritis of the knees.
Highlights
Osteoarthritis (OA) of the knee is a common orthopedic disorder that causes pain, stiffness, and functional disability in daily activities [1]
The results demonstrated that extracorporeal shockwave therapy (ESWT) was an effective and alternative therapy than hyaluronic acid (HA) and non-steroid anti-inflammatory drugs (NSAIDs) for early osteoarthritis of the knees
The serum levels of ALK-P, osteoclacin, cartilage oligometric protein (COMP), insulin-like growth factor 1 (IGF-1), and CTX-II were measured by enzyme-linked immunosorbent assay (ELISA) assay
Summary
Osteoarthritis (OA) of the knee is a common orthopedic disorder that causes pain, stiffness, and functional disability in daily activities [1]. Inflammation-induced transforming growth factor beta (TGFβ), connective tissue growth factor (CTGF), bone morphogenetic protein-2 (BMP-2), BMP-5, and BMP-6 caused synovial and articular cartilage fibrosis and death in severe knee OA [3,4]. The increase in subchondral bone stiffness decreases the ability to scatter the loading forces within the knee joint, which increases the force loaded on articular cartilage. The focus of treatment in early knee OA have shifted from the articular cartilage to the subchondral bone. Recent studies demonstrated that application of ESWT to the subchondral bone in the medial tibia condyle showed regression of early knee OA in rats [14]. ESWT has shown effectiveness in the regression of early OA of the knee associated with decreased cartilage degradation and improves the subchondral bone remodeling in rats [17].
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