Background: Ozone therapy has been used widely to decrease pain related to osteoarthritis, but the effectiveness of this treatment has not been evaluated.
Objective: To evaluate the effectiveness of ozone therapy in the reduction of pain in patients with knee osteoarthritis, according to the type of intervention and duration of the effect. TYPE: Meta-analysis.
Literature survey: We performed an online search using PUBMED, DIALNET, SCIELO, MEDIGRAPHIC, and ISCO3 databases. We searched for articles published up to January 2018.
Participants: We selected eight studies including a total of 355 patients and 363 controls.
Methodology: Only randomized-controlled trials that assessed the efficacy of intraarticular or periarticular infiltrations with ozone to treat knee osteoarthritis in humans were included in the analysis. The results are expressed as standardized mean difference and 95% confidence intervals. The meta-analysis was performed in accordance with the statement of Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Synthesis: We observed that ozone treatment had a therapeutic effect when compared with placebo (d = -0.81, 95% CI -1.06 to -0.55, I2 = 34.79, P(Q) = .47) or other noninvasive treatments. No significant effects were found in favor of the ozone treatment when compared with the use of hyaluronic acid or platelet-rich plasma. However, the use of ozone had a significant short-term benefit reducing knee pain (d = -2.26, 95% CI -2.26 to -3.72, I2 = 97, P(Q) < .001). Pain relief benefits lasted between 3 and 6 months.
Conclusion: Our results indicate that intraarticular infiltrations of ozone can be used as an optional effective treatment for the management of pain related to knee osteoarthritis. There are short-term effect benefits that peak at around 1 month of treatment, with a gradual decline in efficacy after 3 to 6 months of treatment. More studies are needed to improve our understanding of the efficacy of this interventional treatment.
Level of evidence: I.
© 2019 American Academy of Physical Medicine and Rehabilitation.