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Shockwave contraindications

Hello, I have been unable to find a consistent answer as to whether radial shockwave therapy is suitable or contraindicated over joint replacements or metal plates? Ie in a patient struggling with hip bursitis/tendinopathy following a THR.

I was also wondering if there were any contraindications with patients suffering heart conditions such as atrial fibrillation etc and if there were any age limits regarding shockwave/if it is suitable for those over 80?

Thanks in advance ☺️

Simone Boehm

1 year ago

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Prof Tim Watson
Prof Tim Watson

Simon. Cliff beat me to to it! I would concur with his comments and they would be in agreement with the updated contraindication material in the updated textbook. Certainly if you are using Radial shockwave and the patient has had an arthroplasty, I can see nothing in the evidence which identifies a known risk. Different if you are using focused and aiming it directly into / at the replacement - but that is a different issue. Also agree with him that if it is a bursitis, best not to shockwave - distinct potential to make it worse! Tim


Hi Cliff,

That’s great thanks very much for addressing all aspects of my questions, it’s been very helpful.

I’ve sent correspondence to my patients surgeon given she is only 10 months post op to see if he would be happy to use SWT (best to ge their approval I would think)

Thanks again!


Cliff Eaton
Cliff Eaton

Dear Simon Look out for Prof Tim Watson's new book on electrophysical agents: evidence based practice (Elsevier). In this book he has tried to provide the definitive guide, based on current evidence, for all EPA contraindications including RPW In answer to your question there are currently no clinical trials to suggest that RPW will have an adverse effect on hip and knee replacements. That said as some Orthopaedics surgeons use shockwave to help remove cemented in prostheses, that require revision, then caution should be made. If the prosthesis has been in a while then it is unlikely RPW will have an adverse effect. A new prosthesis that has been cemented in place may be more at risk So unfortunately there is no definitive answer to your question. It must be a clinical decision. My mantra being if in doubt don't and the you cannot be wrong To pick up on one point you made: If you consider hip pathology as being an insertional tendinopathy then RPW should help. If, however, you are dealing with a true trochanteric bursitis then ROW is likely to make it worse. It is after all a pro inflammatory modality. Atrial fibrillation and age are not contraindicated. I trust that helps Best wishes Cliff

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