Extracorporeal Shockwave Therapy for Greater Trochanteric Pain Syndrome: A Systematic Review with Meta-Analysis of Randomized Clinical Trials.

IF 2.4 Q2 SURGERY

JBJS Reviews Pub Date : 2024-08-20 eCollection Date: 2024-08-01 DOI:10.2106/JBJS.RVW.24.00091

Hye Chang Rhim, Jaehyung Shin, Alexandra Beling, Raymond Guo, Xiaoyu Pan, Wilma Afunugo, Joseph Ruiz, Michael N Andrew, James Kim, Adam S Tenforde

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引用次数: 0

Abstract

Background: Greater trochanteric pain syndrome (GTPS) affects 17.6% of adults aged 50 to 79 years, particularly women. While exercise therapy and corticosteroid injections (CSIs) are common treatments, their limitations include inadequate pain control and potential tendon weakening. Extracorporeal shockwave therapy (ESWT) is an emerging alternative for GTPS. This systematic review assessed ESWT's efficacy in GTPS by evaluating pain and functional outcomes at different follow-up intervals.

Methods: A literature search of PubMed, Embase, and Web of Science for randomized clinical trials (RCTs) was conducted comparing ESWT with other GTPS treatments up to March 1, 2024. Two reviewers independently extracted data, assessing study quality using the Cochrane risk-of-bias tool. A random-effects pairwise meta-analysis compared ESWT with other treatments.

Results: Eight RCTs involving 754 patients (169 male, 585 female patients) were included. Seven RCTs were deemed high risk of bias, and 1 RCT had some concerns. Five RCTs investigated focused on focused ESWT, and 3 examined radial ESWT. ESWT provided significantly lower pain scores than other treatments at 2 to 4 months (standardized mean difference = -0.431; 95% confidence interval [CI], -0.82 to -0.039; I2 = 83%). Functional improvement (Lower Extremity Functional Scale) was significantly higher at 6 months (weighted mean difference = 6.68; 95% CI, 3.11-10.25; I2 = 0%) but did not exceed the minimal clinically important difference. Focused ESWT provided greater pain reduction than radial ESWT.

Conclusion: Three weekly ESWT sessions offer short-term pain relief at 2 to 4 months for patients with GTPS, especially with focused ESWT. Functional improvements at 6 months were notable but not clinically significant. These findings suggest ESWT may complement or serve as an alternative to CSIs and exercise. However, caution is needed when interpreting these results due to high risk of bias with the included RCTs and heterogeneity across the studies. Further high-quality trials are needed to confirm ESWT's long-term benefits over other treatments.

Level of evidence: Level II. See Instructions for Authors for a complete description of levels of evidence.

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治疗大转子疼痛综合征的体外冲击波疗法：随机临床试验的系统回顾与 Meta 分析》。

背景：大转子疼痛综合征（GTPS）影响着 17.6% 年龄在 50 至 79 岁之间的成年人，尤其是女性。虽然运动疗法和皮质类固醇注射（CSI）是常见的治疗方法，但它们的局限性包括疼痛控制不充分和潜在的肌腱减弱。体外冲击波疗法（ESWT）是治疗 GTPS 的新兴替代疗法。这篇系统性综述通过评估不同随访间隔期的疼痛和功能结果，评估了 ESWT 对 GTPS 的疗效：在PubMed、Embase和Web of Science中检索了截至2024年3月1日的随机临床试验（RCT）文献，比较了ESWT与其他GTPS治疗方法。两名审稿人独立提取数据，并使用 Cochrane 偏倚风险工具评估研究质量。随机效应配对荟萃分析比较了 ESWT 与其他治疗方法：共纳入 8 项研究，涉及 754 名患者（男性 169 名，女性 585 名）。7项研究被认为存在高偏倚风险，1项研究存在一些问题。其中 5 项研究重点研究了聚焦 ESWT，3 项研究了径向 ESWT。在 2 至 4 个月内，ESWT 的疼痛评分明显低于其他疗法（标准化平均差异 = -0.431；95% 置信区间 [CI]，-0.82 至 -0.039；I2 = 83%）。6个月后，功能改善（下肢功能量表）明显增加（加权平均差异 = 6.68；95% CI，3.11-10.25；I2 = 0%），但未超过最小临床重要性差异。与桡侧 ESWT 相比，聚焦 ESWT 的镇痛效果更好：结论：每周三次的 ESWT 治疗可在 2 至 4 个月内缓解 GTPS 患者的短期疼痛，尤其是聚焦 ESWT 治疗。6 个月后，功能改善显著，但临床意义不大。这些研究结果表明，ESWT 可以补充或替代 CSIs 和运动。然而，由于所纳入的 RCT 存在较高的偏倚风险，且各研究之间存在异质性，因此在解释这些结果时需要谨慎。需要更多高质量的试验来证实 ESWT 的长期疗效优于其他疗法：证据等级：二级。有关证据级别的完整描述，请参阅 "作者须知"。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JBJS Reviews SURGERY-

CiteScore

4.40

自引率

4.30%

发文量

132

期刊介绍： JBJS Reviews is an innovative review journal from the publishers of The Journal of Bone & Joint Surgery. This continuously published online journal provides comprehensive, objective, and authoritative review articles written by recognized experts in the field. Edited by Thomas A. Einhorn, MD, and a distinguished Editorial Board, each issue of JBJS Reviews, updates the orthopaedic community on important topics in a concise, time-saving manner, providing expert insights into orthopaedic research and clinical experience. Comprehensive reviews, special features, and integrated CME provide orthopaedic surgeons with valuable perspectives on surgical practice and the latest advances in the field within twelve subspecialty areas: Basic Science, Education & Training, Elbow, Ethics, Foot & Ankle, Hand & Wrist, Hip, Infection, Knee, Oncology, Pediatrics, Pain Management, Rehabilitation, Shoulder, Spine, Sports Medicine, Trauma.