Honey Phonophoresis as an Adjunctive Multimodal Intervention in Knee Osteoarthritis: A Case Report

To clarify the clinical, imaging, and laboratory changes after application of honey phonophoresis combined with conventional physiotherapy in a patient with knee osteoarthritis (OA).

A 55-year-old male with Grade II medial knee osteoarthritis presented with chronic pain, morning stiffness, and functional limitations. Baseline assessment included pain intensity, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), musculoskeletal ultrasound (MSK-US) evaluation of medial femoral cartilage thickness, and systemic inflammatory markers. The patient underwent a four-week multimodal physiotherapy program consisting of honey phonophoresis applied to the medial tibiofemoral compartment, transcutaneous electrical nerve stimulation (TENS), and supervised quadriceps strengthening exercises.

Following the intervention, pain intensity decreased from 8/10 to 4/10, and the total WOMAC score improved from 58/96 to 43/96. MSK-US demonstrated increased medial femoral cartilage thickness on both longitudinal (0.26 to 0.30 cm) and transverse (0.20 to 0.26 cm) posterior views. Systemic inflammatory markers also improved, with C-reactive protein decreasing from 8.08 to 5.2 mg/L and erythrocyte sedimentation rate from 29 to 18 mm/h. No adverse events were observed.

Integration of honey phonophoresis with conventional physiotherapy in this single case may be associated with improvements in the patient's reported outcomes, cartilage ultrasound assessment, and inflammatory biomarkers in OA. Causal relationships cannot be inferred from a single case due to the uncontrolled, multimodal design; thus, imaging changes should be interpreted cautiously. The findings of this case are exploratory and hypothesis-generating, supporting further investigation through well-designed randomized controlled trials.