Efficacy and safety of extracorporeal shock wave therapy combined with sodium hyaluronate in treatment of knee osteoarthritis: a systematic review and Meta-analysis

doi:10.19852/j.cnki.jtcm.20231226.002

Journal of Traditional Chinese Medicine ›› 2024, Vol. 44 ›› Issue (2): 243-250.DOI: 10.19852/j.cnki.jtcm.20231226.002

• Meta-Analyses • Previous Articles Next Articles

Efficacy and safety of extracorporeal shock wave therapy combined with sodium hyaluronate in treatment of knee osteoarthritis: a systematic review and Meta-analysis

ZHOU Mingwang¹, DONG Zhuanli², WEI Changhao³, FENG Lufang⁴^,⁵^,⁶, WANG Xiaoping⁷, LIU Haiping⁷, JI Xing⁷, YANG Kehu⁴^,⁵^,⁶(), LI Shenghua⁸()

1 Department of Orthopaedics, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou 730050, China
2 Department of Quality Management, Lanzhou Petrochemical General Hospital, Lanzhou 730050, China
3 Department of Orthopaedics, Lanzhou Petrochemical General Hospital, Lanzhou 730050, China
4 Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China
5 Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
6 Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, China
7 Center for Translational Medicine, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou 730050, China
8 Department of Orthopaedics, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou 730000, China

Received:2022-09-26 Accepted:2023-01-18 Online:2024-04-15 Published:2023-12-26
Contact: Prof. LI Shenghua, Department of Orthopaedics, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou 730000, China. Medicweich@163.com; Prof. YANG Kehu, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, China. kehuyangebm2006@126.com Telephone: +86-931-2687795
Supported by:
Natural Science Foundation-funded Project: Yang Deficiency Constitution of Knee Osteoarthritis and the Wnt/β-catenin Signaling Pathway Regulates the Level of Correlation, and the Constitution Theraphy(81260546);Construction Project of Chinese Medicine Inheritance Innovation Platform: Basic and Clinical Application Research on Osteoarthritis of the Knee(Gan Wei Chinese Medicine Letter [2020] No. 203);Gansu Provincial Science and Technology Plan Project: Clinical Medical Research Centre for Bone and Joint Degenerative Diseases(18JR2FA009)

1. .pdf(205KB)

Abstract

Abstract:

OBJECTIVE: To assess the efficacy and safety of extracorporeal shockwave therapy (ESWT) combined with sodium hyaluronate (HA) for the treatment of knee osteoarthritis (KOA).

METHODS: PubMed, Embase, the Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang database, China Science and Technology Journal Database, and SinoMed were searched from inception to July 2020. The quality of the randomized controlled trials was evaluated independently by two reviewers according to the criteria in the Cochrane Collaboration for Systematic Reviews. The identified articles were then screened individually using EndnoteX9 for eligibility in this Meta-analysis. The heterogeneity among the articles was evaluated using I2.

RESULTS: A total of 17 studies, comprising 2000 individuals, were included in this Meta-analysis. The results showed that a significant improvement was observed in knee pain and function based on the clinical efficacy of ESWT combined with HA. Statistical analysis of clinical efficacy showed that [relative risk (RR) = 1.21, 95% confidence interval (CI) (1.12, 1.30), P < 0.01]. Statistical analysis of visual analog scale showed that [standardized mean difference (SMD) = －2.84, 95%CI (－4.01, －1.66), P < 0.01]. Western Ontario and McMaster University osteoarthritis index statistical analysis showed that [SMD = －1.57, 95% CI (－2.52, －0.61), P < 0.01]. Lysholm score statistical analysis showed that [SMD = 1.71, 95% CI (0.98, 2.44), P < 0.01]. In addition, only minor side effects, such as redness and swelling of the skin, were observed.

CONCLUSIONS: Medium to low quality evidence showed that ESWT combined with HA offers an inexpensive, well-tolerated, safe, and effective method to improve pain and functionality in patients with KOA. However, tightly controlled, randomized, large multicenter trials are warranted to validate the current findings.

Key words: osteoarthritis, knee, randomized controlled trial, extracorporeal shockwave therapy, hyaluronic acid, Meta-analysis

ZHOU Mingwang, DONG Zhuanli, WEI Changhao, FENG Lufang, WANG Xiaoping, LIU Haiping, JI Xing, YANG Kehu, LI Shenghua. Efficacy and safety of extracorporeal shock wave therapy combined with sodium hyaluronate in treatment of knee osteoarthritis: a systematic review and Meta-analysis[J]. Journal of Traditional Chinese Medicine, 2024, 44(2): 243-250.

Figures/Tables 6

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Study	Sample size EG/CG	Sex (M/F)		Age (years)		Duration of disease (years)		Intervention		Outcome
Study	Sample size EG/CG	EG	CG	EG	CG	EG	CG	EG	CG	Outcome
Wang KT et al 2020²²	57/55	28/29	26/29	57.4±10.10	62.18±7.89	4.57±3.24	4.58±3.02	ESWT+HA	HA	①②⑤
Wang GR et al 2019²³	48/48	20/28	21/27	64.94±4.75	65.28±4.83	5.61±2.26	5.49±2.30	ESWT+HA	HA	④
Sun LM et al 2015²⁴	40/38	22/18	20/18	64.10±9.70	63.40±9.50	9.10±7.60	9.60±7.50	ESWT+HA	HA	②④⑤
Su WZ et al 2018²⁵	80/80	28/52	24/56	58.35±12.56	57.65±10.53	3.13±0.94	3.22±1.01	ESWT+HA	HA	①②
Pan K et al 2018²⁶	25/25	NA	NA	NA	NA	NA	NA	ESWT+HA	HA	②
Meng Y et al 2016²⁷	67/65	NA	NA	NA	NA	NA	NA	ESWT+HA	HA	①④
Li ZC et al 2017²⁸	39/39	18/21	15/24	65.31±7.56	64.55±8.38	5.52±2.28	5.49±3.45	ESWT+HA	HA	③④
Huang SX et al 2020²⁹	27/27	10/17	12/15	48.30±9.60	46.90±6.80	NA	NA	ESWT+HA	HA	④
Han FM et al 2017³⁰	38/38	20/18	19/19	59.71±11.87	61.39±11.57	1.47±2.06	1.59±2.14	ESWT+HA	HA	④
Duan JF et al 2016³¹	49/49	18/31	12/37	68.13±5.89	68.13±5.75	5.14±1.14	5.49±3.45	ESWT+HA	HA	①③④
Ding YY et al 2015³²	50/50	19/31	21/29	68.20±5.90	67.30±6.60	3.30±2.40	3.10±2.20	ESWT+HA	HA	①③④
Chi X et al 2018³³	43/43	19/24	22/21	60.30±4.70	60.80±4.90	8.50±1.50	8.80±1.70	ESWT+HA	HA	①③④
Liu SC et al 2019³⁴	35/35	13/22	15/20	66.80±9.10	68.20±10.30	14.00±3.80	15.20±4.20	ESWT+HA	HA	①②⑤
Yin Q et al 2015³⁵	25/25	0/25	0/25	71.34±5.22	71.34±5.22	7.53±2.21	7.53±2.21	ESWT+HA	HA	⑤
Shi CA et al 2020³⁶	40/40	14/26	13/27	66.40±9.20	65.40±9.90	8.40±2.10	8.10±2.90	ESWT+HA	HA	①②⑤
Xi FF et al 2019³⁷	30/30	14/16	15/15	68.00±7.00	64.00±9.00	6.50±2.20	6.40±2.30	ESWT+HA	HA	①②⑤
Xu H et al 2020³⁸	310/310	156/154	150/160	63.20±2.60	64.20±2.80	4.50±0.60	5.10±0.70	ESWT+HA	HA	①③④

Study	Sample size EG/CG	Sex (M/F)		Age (years)		Duration of disease (years)		Intervention		Outcome
Study	Sample size EG/CG	EG	CG	EG	CG	EG	CG	EG	CG	Outcome
Wang KT et al 2020²²	57/55	28/29	26/29	57.4±10.10	62.18±7.89	4.57±3.24	4.58±3.02	ESWT+HA	HA	①②⑤
Wang GR et al 2019²³	48/48	20/28	21/27	64.94±4.75	65.28±4.83	5.61±2.26	5.49±2.30	ESWT+HA	HA	④
Sun LM et al 2015²⁴	40/38	22/18	20/18	64.10±9.70	63.40±9.50	9.10±7.60	9.60±7.50	ESWT+HA	HA	②④⑤
Su WZ et al 2018²⁵	80/80	28/52	24/56	58.35±12.56	57.65±10.53	3.13±0.94	3.22±1.01	ESWT+HA	HA	①②
Pan K et al 2018²⁶	25/25	NA	NA	NA	NA	NA	NA	ESWT+HA	HA	②
Meng Y et al 2016²⁷	67/65	NA	NA	NA	NA	NA	NA	ESWT+HA	HA	①④
Li ZC et al 2017²⁸	39/39	18/21	15/24	65.31±7.56	64.55±8.38	5.52±2.28	5.49±3.45	ESWT+HA	HA	③④
Huang SX et al 2020²⁹	27/27	10/17	12/15	48.30±9.60	46.90±6.80	NA	NA	ESWT+HA	HA	④
Han FM et al 2017³⁰	38/38	20/18	19/19	59.71±11.87	61.39±11.57	1.47±2.06	1.59±2.14	ESWT+HA	HA	④
Duan JF et al 2016³¹	49/49	18/31	12/37	68.13±5.89	68.13±5.75	5.14±1.14	5.49±3.45	ESWT+HA	HA	①③④
Ding YY et al 2015³²	50/50	19/31	21/29	68.20±5.90	67.30±6.60	3.30±2.40	3.10±2.20	ESWT+HA	HA	①③④
Chi X et al 2018³³	43/43	19/24	22/21	60.30±4.70	60.80±4.90	8.50±1.50	8.80±1.70	ESWT+HA	HA	①③④
Liu SC et al 2019³⁴	35/35	13/22	15/20	66.80±9.10	68.20±10.30	14.00±3.80	15.20±4.20	ESWT+HA	HA	①②⑤
Yin Q et al 2015³⁵	25/25	0/25	0/25	71.34±5.22	71.34±5.22	7.53±2.21	7.53±2.21	ESWT+HA	HA	⑤
Shi CA et al 2020³⁶	40/40	14/26	13/27	66.40±9.20	65.40±9.90	8.40±2.10	8.10±2.90	ESWT+HA	HA	①②⑤
Xi FF et al 2019³⁷	30/30	14/16	15/15	68.00±7.00	64.00±9.00	6.50±2.20	6.40±2.30	ESWT+HA	HA	①②⑤
Xu H et al 2020³⁸	310/310	156/154	150/160	63.20±2.60	64.20±2.80	4.50±0.60	5.10±0.70	ESWT+HA	HA	①③④

Study	Type	Frequency	Time	Interval of treatment (days)	Intensity of pressure (bar)
Wang KT et al 2020²²	Focused	2500	5	7	1.5-2.5
Wang GR et al 2019²³	Focused	1000	5	7	3.0
Sun LM et al 2015²⁴	Diffuse	2000-3000	5	7	1.4-3.0
Su WZ et al 2018²⁵	Focused	1000-2000	5	7	1.2-2.0
Pan K et al 2018²⁶	Focused	1000	5	7	3.0
Meng Y et al 2016²⁷	NA	3000-4000	4	2	1.5
Li ZC et al 2017²⁸	Diffuse	2000	5	7	3.0
Huang SX et al 2020²⁹	NA	NA	4	7	NA
Han FM et al 2017³⁰	NA	2500	5	7	3.0
Duan JF et al 2016³¹	NA	2000	5	7	2.0-3.0
Ding YY et al 2015³²	NA	2000	5	7	2.0-3.0
Chi X et al 2018³³	NA	2000	10	7	NA
Liu SC et al 2019³⁴	NA	4000	8	7	2.5
Yin Q et al 2015³⁵	NA	2000	3	7	1.4-2.0
Shi CA et al 2020³⁶	Diffuse	2000	5	7	3
Xi FF et al 2019³⁷	NA	2000	5	7	2.5
Xu H et al 2020³⁸	Diffuse	2000	4	7	2

Study	Type	Frequency	Time	Interval of treatment (days)	Intensity of pressure (bar)
Wang KT et al 2020²²	Focused	2500	5	7	1.5-2.5
Wang GR et al 2019²³	Focused	1000	5	7	3.0
Sun LM et al 2015²⁴	Diffuse	2000-3000	5	7	1.4-3.0
Su WZ et al 2018²⁵	Focused	1000-2000	5	7	1.2-2.0
Pan K et al 2018²⁶	Focused	1000	5	7	3.0
Meng Y et al 2016²⁷	NA	3000-4000	4	2	1.5
Li ZC et al 2017²⁸	Diffuse	2000	5	7	3.0
Huang SX et al 2020²⁹	NA	NA	4	7	NA
Han FM et al 2017³⁰	NA	2500	5	7	3.0
Duan JF et al 2016³¹	NA	2000	5	7	2.0-3.0
Ding YY et al 2015³²	NA	2000	5	7	2.0-3.0
Chi X et al 2018³³	NA	2000	10	7	NA
Liu SC et al 2019³⁴	NA	4000	8	7	2.5
Yin Q et al 2015³⁵	NA	2000	3	7	1.4-2.0
Shi CA et al 2020³⁶	Diffuse	2000	5	7	3
Xi FF et al 2019³⁷	NA	2000	5	7	2.5
Xu H et al 2020³⁸	Diffuse	2000	4	7	2

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Efficacy and safety of extracorporeal shock wave therapy combined with sodium hyaluronate in treatment of knee osteoarthritis: a systematic review and Meta-analysis

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