title: Radial extracorporeal shock wave therapy for disabling pain due to severe primary knee osteoarthritis.
abstract: OBJECTIVE
  To assess the efficacy and safety of radial extracorporeal shock wave therapy (rESWT) for disabling pain due to primary knee osteoarthritis.
  
  
  METHODS
  Randomized, placebo-controlled trial (level of evidence, 1).
  
  
  METHODS
  A total of 105 women with disabling pain due to primary knee osteoarthritis lasting for a mean of 103 months (range 3-480 months).
  
  
  METHODS
  Patients received either rESWT (3 sessions, each one week apart, 2,000 rESWT impulses per session, positive energy flux density 0.10-0.16 mJ/mm2) or placebo treatment. Primary outcome measure was pain on movement 3 months after the final treatment session. Secondary outcomes were pain, stiffness and limitations in physical function on the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index and the level of tolerance to pressure over muscles, tendons, ligaments and skin at both the treated and the untreated side at 1 week and 3 months follow-up examinations.
  
  
  RESULTS
  Compared with placebo treatment, rESWT led to a statistically significant improvement only in mean WOMAC scores for pain and a few of the pressure measurements.
  
  
  CONCLUSIONS
  rESWT, as performed in the present study, is not efficient for treating patients with disabling pain due to primary knee osteoarthritis. Published data indicate that substantially higher energy flux densities are necessary for treatment success in this condition.
authors.affiliation: Institute of Physical and Rehabilitation Medicine, University of São Paulo School of Medicine, São Paulo, Brasil. martaimf2@gmail.com, marta@imf.org.br, martaimf@gmail.com, Martaimf5@gmail.com, marta.imamura@fm.usp.br.
authors.forename: Marta
authors.initials: M
authors.lastname: Imamura
authors.forename: Sandra
authors.initials: S
authors.lastname: Alamino
authors.forename: Wu Tu
authors.initials: WT
authors.lastname: Hsing
authors.forename: Fábio Marcon
authors.initials: FM
authors.lastname: Alfieri
authors.forename: Christoph
authors.initials: C
authors.lastname: Schmitz
authors.forename: Linamara Rizzo
authors.initials: LR
authors.lastname: Battistella
mesh_terms: D000368:Aged; D004311:Double-Blind Method; D005260:Female; D019220:High-Energy Shock Waves / Q000627:therapeutic use*; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology*; D008297:Male; D020370:Osteoarthritis, Knee / Q000503:physiopathology*; D010146:Pain / Q000532:radiotherapy*; D010147:Pain Measurement / Q000379:methods*; D016896:Treatment Outcome