Objective To explore the application value of radial extracorporeal shock wave acupoint therapy in the treatment of the elderly patients with knee osteoarthritis (KOA) and to analyze its mechanism. Methods The study selected 108 elderly KOA patients admitted to Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from January 2018 to June 2019. They were randomized into drug group and shock wave group, with 54 in each group. The former was treated with drug therapy, and the latter with radial extracorporeal shock wave acupoint therapy. The visual analogue scale (VAS), Lysholm score, serum supero-xide dismutase (SOD), tumor necrosis factor-α (TNF-α) and the incidence of related complications were compared between the two groups before and after treatment. SPSS statistics 20.0 was used for data analysis. According to different data type, t test, analysis of variance or χ² test was used for data comparison between two groups.Results The VAS score of the shock wave group was lower than that of the drug group after treatment, and the Lysholm score was higher than that of the drug group after treatment and 6 months later (P<0.05). After treatment, the SOD of the shock wave group was higher than that of the drug group, and TNF-α was lower than that of the drug group (P<0.05). There was no statistically significant difference in the complication rate between the shock wave group and the drug group (P>0.05). Conclusion Compared with drug therapy, radial extracorporeal shock wave acupoint therapy can promote the recovery of joint function, which may be related to its further reduction of oxidative stress and inflammation.