Comparison of Extracorporeal Shockwave Therapy versus Intra-Articular Injections of Hyaluronic Acid for the Treatment of Knee Osteoarthritis

Objective: To compare efficacy of extracorporeal shock wave therapy (ESWT) versus intra-articular injections of hyaluronic acid (HA) in the treatment of knee osteoarthritis. Study Design: Quasi experimental study Place and Duration of Study: Department of Rehabilitation Medicine, Pakistan Air Force Hospital, Islamabad Pakistan, from Jan to Jul 2022. Methodology: The total of 100 patients meeting inclusion criteria were randomly assigned to two groups. Group A patients underwent 3 x sessions of ESWT at weekly intervals with treatment protocol of 1000 shockwave pulses at intensity of 0.25mJ/mm2. Group B, patients underwent 3 x injections of Hyaluronic Acid (32 ml/2ml) at weekly intervals. Severity of knee pain on Visual Analogue scale was calculated at baseline, four weeks and twelve weeks after the intervention. Results: At baseline Median ESWT VAS scores were 6(3). HA group VAS score was 6(2). At 4 weeks following the intervention, VAS ratings improved in both groups, with ESWT VAS of 2(2) and HA VAS of 2(1). At 12 weeks, median (IQR) of 3(0). HA group Median VAS scores were of 2(1), a statistically significant difference between both groups. Treatment with intraarticular injections of hyaluronic acid was therefore found to be more effective than Shockwave Therapy in providing long-term pain relief in knee osteoarthritis. Conclusion: Hyaluronic acid and ESWT are both equally effective in providing short-term pain relief in knee OA, with Hyaluronic Acid proving more effective in the long term.