3. Discussion
knee OA, shock, knee osteoarthritis, pain, ’ pain
ADVERSE EVENTS, KNEE OSTEOARTHRITIS, SHOCK
According to our results, treatments with OT and HA injections are able to produce similar positive results in patients’ pain control and function recovery. Although these data are preliminary and need to be confirmed on a larger study population, they raise some interesting considerations. Both groups improved with statistical significance over baseline in all outcomes measured from 1-month post-treatment and remained stable, showing only a trend toward slight worsening up to 6 months. No significant differences were found between the two treatments in pain scores. Concerning scores regarding function and quality of life, although without statistical significance HA seems to show a slightly better trend at 3 months (KOOS) and 6 months follow-up (KOOS and WOMAC tot). Both therapies appeared to be safe: the few adverse events recorded were mild and self-limiting.Ozone gas was discovered in 1840, and its expansion into the medical field has given rise to exciting research in recent decades to validate its clinical value [Looking at the available literature, an overall modest methodological quality has been underlined by recent systematic reviews and meta-analyses [On the other hand, HA has already a large body of evidence on its safety and efficacy as a conservative treatment of knee OA, due to its mechanical and viscoelastic properties of shock absorption and improvement of joint lubrication, as well as its anti-inflammatory and cartilage-protective actions [From what has been discussed so far, the positive result that O3 and HA achieved on pain control in our study is understandable. What is more complex, and certainly requires confirmation on larger case series, is to explain the rapid positive functional recovery achieved at WOMAC and KOOS scores. Usually, better control of pain symptoms can lead to a progressive and slower improvement in motor and functional abilities. One explanation for this could be related to the different etiopathogenetic hypotheses related to knee osteoarthritis and consequently to the possibility that one type is more present in our limited study sample. In fact, both O3 and HA have different mechanisms of action that may be effective for the treatment of knee OA [In recent years, several studies have already tried to compare the effectiveness of O3 and HA in the treatment of knee OA [In more detail, in 2016 Giombini et al. compared the IA injection of O3, HA, and a combined therapy of both [The present study has several limitations. First, the small sample size of the analyzed cohort prevents robust data analysis on the efficacy of OT compared with HA. Another limitation of the study is that we were unable to draw definitive conclusions about the long-term effects of the treatment. Furthermore, no radiographic or biochemical data are available for comparison. Future prospects lay in performing studies that can confirm these preliminary results on a larger cohort of patients, evaluated at a longer follow-up (at least 1 year), by also using imaging data as well as biochemical parameters (e.g., the level of inflammatory cytokines in synovial fluid or blood).