Attending Physician University of Toledo Toledo, Ohio, United States
Case Diagnosis: Mild-Moderate Knee Osteoarthritis
Case Description: A 77-year-old male with a history of CAD s/p CABG, EF of approximately 35%, and Diabetes Mellitus Type-2 returns to clinic 6 weeks following corticosteroid injection of the left knee for longstanding osteoarthritis, reporting minimal relief. He has completed hyaluronic acid injections as well as physical therapy, both with only minor improvement. Recent left knee X-rays confirm tricompartmental OA of mild-moderate degree. Previously, patient was walking 2-3 miles per day; however, over the past 6 months, pain has prevented this as well as other activities he previously enjoyed. Based on the protocol performed by Kim et al., the patient returns for ESWT for a total of three weekly sessions. He then returns at 3, 6, and 12 month follow-up visits, each time confirming pain relief along with improvement of activities of daily living.
Discussions: The objective of this hypothetical case is to highlight the potential use and application of ESWT for knee osteoarthritis. Currently, multiple interventions are available; however, each presents inherent benefits and risks. Meta-analysis studies utilizing ESWT demonstrate both pain relief and increased function at 3, 6, and 12 month follow-up (Ying-Chun et al. 2020). Studies have also demonstrated chondroprotective effects (Wang et al. 2012) as well as increased growth factors which are beneficial to joint health (Waugh et al. 2015). This emerging technology warrants further consideration for patients with knee OA, especially those who are deemed poor surgical candidates.
Conclusions: In the treatment of knee osteoarthritis, ESWT demonstrated both short and long-term pain relief as well as increased function (Ying-Chun et al. 2020). Knee OA is particularly disabling given the joint’s weight-bearing activities and contribution to general mobility, thus proper management is fundamental for mitigating symptoms and maintaining quality of life. ESWT offers an additional solution for patients in modulating pain and restoring function.