Introduction: Extracorporeal shockwave therapy (ESWT) is used as an adjunctive treatment for canine osteoarthritis (OA), but its effects in dogs with treatment-refractory advanced disease remain unclear. This study compared the efficacy of one versus two sessions of focused ESWT administered approximately 28 days apart in dogs with refractory elbow or stifle OA. Methods: In this randomized, double-blinded clinical trial, twenty-four client-owned dogs with treatment-refractory elbow (n = 12) or stifle (n = 12) osteoarthritis received ESWT using an identical per-session protocol (X-Trode, 1000 pulses at 0.14 mJ/mm2; PulseVet-Zomedica, Ann Arbor, MI, USA), once (Group L) or twice (Group E). Orthopedic examination, goniometric and limb circumference measurements, and kinetic gait analysis (peak vertical pressure PVP, vertical impulse VI) were performed on days 0, 28, and 56. Owner questionnaires (Canine Brief Pain Inventory CBPI, Client Specific Outcome Measures CSOM) were collected on days 0, 28, 56, and 84. Data were analyzed using chi-squared tests, t-tests, and mixed effects models in R. Results: Age, weight, BCS, and radiographic osteoarthritis severity did not differ between groups at baseline. Improvement was small and limited to selected parameters. Vertical impulse and limb circumference increased more consistently in Group E, whereas peak vertical pressure increased in both groups, including before ESWT in Group L. No sustained or treatment-associated improvement was detected in symmetry variables or joint range of motion. Owner-reported outcomes showed variable patterns without consistent treatment effects. ESWT was well tolerated, and no major adverse events occurred. Conclusion: ESWT produced modest, inconsistent improvements in dogs with treatment-refractory OA, with slightly more consistent effects following two sessions. Therapeutic efficacy appeared limited in this end-stage population.
Klein et al. (Mon,) studied this question.