Guideline for the management of knee and hip osteoarthritis

Recommendations

Therapeutic ultrasound

Guideline for the management of knee and hip osteoarthritis
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Non-pharmacological interventions 

Therapeutic ultrasound


 

Therapeutic ultrasound – Knee and/or hip

Recommendation

We suggest not offering therapeutic ultrasound for people with knee and/or hip osteoarthritis (OA).

Strength of recommendation

Conditional against recommendation

Quality of evidence

Moderate (knee)
Low (hip)

Recommendation

What is it? 

Therapeutic ultrasound is the application of high-frequency sound waves to soft tissues via a treatment head moved over the surface of the skin. It is a passive treatment typically provided by a clinician over a number of treatment sessions. 

Rationale 

There is moderate-quality evidence that therapeutic ultrasound has statistically significant effects on pain and physical function in people with knee OA. There is no randomised controlled trial (RCT) involving participants with hip OA, thus the evidence level for this population group was downgraded to low quality because of concerns about indirectness (Appendix 5 of the Guideline for the management of knee and hip osteoarthritis: Technical document). Although the evidence suggests moderate effect sizes and a low risk of harms for therapeutic ultrasound in people with knee OA, the working group noted that current evidence is restricted to short-term (two to eight weeks) follow-up only. The working group also expressed concern about whether benefits are sustained once treatment finished. The available evidence suggests that three to five treatment sessions per week are required for benefits. Given the large number of visits required to a health professional for a treatment modality that is passive, and the financial cost this may impose on an individual, the working group felt that therapeutic ultrasound should not be offered to people with knee and/or hip OA.

Harms 

Generally, there is no evidence to suggest that ultrasound therapy is unsafe. In view of its mechanisms of action, ultrasound therapy is rather unlikely to cause serious adverse events, but active surveillance of harms with formal monitoring of potential adverse events is clearly desirable.

Strength of recommendation

Quality of evidence

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