Comparative Effectiveness of Extracorporeal Shockwave Therapy, Platelet-Rich Plasma, and Corticosteroid Injections in Greater Trochanteric Pain Syndrome: A Systematic Review of Randomized Controlled Trials
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Abstract
Background and Objectives: Greater Trochanteric Pain Syndrome (GTPS) is a common condition characterized by chronic lateral hip pain, particularly among females aged 40 to 60. Various non-surgical options, corticosteroid injections (CSI), platelet-rich plasma (PRP) injections, and extracorporeal shockwave therapy (ESWT), are used, but their comparative effectiveness remains uncertain. This systematic review aimed to evaluate the effectiveness of ESWT compared to PRP and CSI in managing GTPS.
Methods: A systematic literature search was conducted in March 2025 across PubMed, OVID Medline, and Embase, following PRISMA guidelines. Randomized controlled trials (RCTs) evaluating ESWT, PRP and CSI for GTPS were included. A total of 16 RCTs met the criteria: 6 on ESWT, 6 on PRP, and 4 on CSI. Methodological quality was assessed using the PEDro scale and Cochrane Risk of Bias Tool. Visual Analogue Scale (VAS) scores were extracted to compare pain outcomes at baseline, 3, 6, and 12 months. The most used tools for function and quality of life were the Harris Hip Score (HHS) and the Modified Harris Hip Score (mHHS).
Results: All three treatments ESWT, PRP, and CSI showed reductions in pain and improvements in function and quality of life, as measured by VAS and other functional scores. 1,275 patients were grouped across 16 RCTs, enhancing consistency and comparability. ESWT showed the greatest pain relief at 3 months (VAS 3.14), compared to PRP (3.39) and CSI (3.78). At 12 months, ESWT and CSI had similar outcomes (VAS 3.71), while PRP had a higher score (4.52). However, variability in treatment protocols and baseline characteristics across study populations limits direct comparison and generalizability.
Discussion and Conclusion: ESWT appears to offer rapid and sustained pain relief and functional benefit in GTPS. CSI offers similar long-term benefits, while PRP shows moderate mid-term promises. GRADE assessment indicates that the overall evidence is of moderate certainty in supporting all three non-surgical interventions for pain reduction in GTPS. However, further high-quality research is warranted.
Keywords
- greater trochanteric pain syndrome (GTPS)
- corticosteroid injections (CSI)
- platelet-rich plasma (PRP)
- extracorporeal shockwave therapy (ESWT)
- Systematic Review
- non-surgical conservative therapies
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