Published December 30, 2023 | Version https://impactfactor.org/PDF/IJPCR/15/IJPCR,Vol15,Issue12,Article231.pdf
Journal article Open

Dextrose Prolotherapy in Osteoarthritis of Knee Joint

  • 1. Assistant Professor, Department of Orthopaedics, BRIMS, Bidar, Karnataka
  • 2. Professor and HOD, Department of Orthopaedics, BRIMS, Bidar, Karnataka

Description

Introduction: Osteoarthritis (OA) of knee joint is a chronic, progressive, and joint disabling disease, often resulting in a poor quality of life. Knee osteoarthritis often results in joint pain, stiffness, and decreased function. The Agency for Healthcare Research and Quality has called for the development of new therapies to prevent and treat knee osteoarthritis. These include hypertonic dextrose prolotherapy, ozone, botulinum toxin, platelet-rich plasma, and hyaluronic acid. Materials and Methods: This prospective study enrolled patients from orthopaedic OPD who were given intra-articular hypertonic dextrose solution which was blinded by normal saline, at BRIMS Teaching Hospital, Bidar , Karnataka. Injections were given at 0, 4, and 8 weeks with additional session at 16 weeks. The primary outcome measure was change in knee-related quality-of-life as assessed by the composite score of Western Ontario McMaster University Osteoarthritis Index (WOMAC). Results: Of the 205 participants considered for inclusion in the study, 76 met eligibility criteria and were enrolled and divided into 2 groups containing 38 participants each. The study participants had a mean age of 63.2 years, 71% were female, 21% were overweight, and 46% were obese. Mean duration of knee pain was 8.9 years. Conclusion: According to our results, dextrose prolotherapy appears to be more effective for pain reduction and function improvement.  More studies and better methodological quality are needed to establish a better level of evidence on the efficacy and safety of using dextrose prolotherapy in patients with knee OA.

 

 

Abstract (English)

Introduction: Osteoarthritis (OA) of knee joint is a chronic, progressive, and joint disabling disease, often resulting in a poor quality of life. Knee osteoarthritis often results in joint pain, stiffness, and decreased function. The Agency for Healthcare Research and Quality has called for the development of new therapies to prevent and treat knee osteoarthritis. These include hypertonic dextrose prolotherapy, ozone, botulinum toxin, platelet-rich plasma, and hyaluronic acid. Materials and Methods: This prospective study enrolled patients from orthopaedic OPD who were given intra-articular hypertonic dextrose solution which was blinded by normal saline, at BRIMS Teaching Hospital, Bidar , Karnataka. Injections were given at 0, 4, and 8 weeks with additional session at 16 weeks. The primary outcome measure was change in knee-related quality-of-life as assessed by the composite score of Western Ontario McMaster University Osteoarthritis Index (WOMAC). Results: Of the 205 participants considered for inclusion in the study, 76 met eligibility criteria and were enrolled and divided into 2 groups containing 38 participants each. The study participants had a mean age of 63.2 years, 71% were female, 21% were overweight, and 46% were obese. Mean duration of knee pain was 8.9 years. Conclusion: According to our results, dextrose prolotherapy appears to be more effective for pain reduction and function improvement.  More studies and better methodological quality are needed to establish a better level of evidence on the efficacy and safety of using dextrose prolotherapy in patients with knee OA.

 

 

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Dates

Accepted
2023-10-05

References

  • 1. Murphy L., Schwartz T.A., Helmick C.G. Lifetime risk of symptomatic knee osteoarthritis. Arthritis Rheum. 2008; 59(9): 1207–1213. 2. Felson DT. Clinical practice. Osteoarthritis of the knee. N Engl J Med. 2006;354(8):841–848 3. Felson DT. The sources of pain in knee osteoarthritis. CurrOpin Rheumatol. 2005; 17(5):624–628. 4. Kulkarni P., Martson A., Vidya R. Pathophysiological landscape of osteoarthritis. AdvClin Chem. 2021; 100:37– 90. 5. Huang Z., Ding C., Li T., Yu S.P. Current status and future prospects for disease modificationinosteoarthritis. Rheumatology. 2 018; 57 (suppl_4): iv108–iv123. 6. Samson DJ, Grant MD, Ratko TA, et al. Treatment of primary and secondary osteoarthritis of the knee. Agency for Healthcare Research and Quality; (Publication No. 07-E012): Evidence Report/ Technology Assessment: Prepared by Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-based Practice Center under Contract No. 290-02-0026). Rockville, MD: 2007; 157. 7. Sconza C., Respizzi S., Virelli L. Oxygenozone therapy for the treatment of knee osteoarthritis: a systematic review of randomized controlled trials. Arthroscopy. 2020; 36(1):277–286. 8. Rabago D., Slattengren A., Zgierska A. Prolotherapy in primary care practice. Prim Care. 2010; 37(1):65–80. 9. Sit R.W., Chung V.C.H., Reeves K.D. Hypertonic dextrose injections (prolotherapy) in the treatment of symptomatic knee osteoarthritis: a systematic review and metaanalysis. Sci Rep. 2016; 6:25247. 10. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15(12):1833–1840 11. Roos EMKM, Klässbo M, Lohmander LS. WOMAC osteoarthritis index. Reliability, validity, and responsiveness in patients with arthroscopically assessed osteoarthritis. Western Ontario and Mac-Master Universities. Scand J Rheumatol. 1999; 28(4):210–215 12. Rejeski WJ, Ettinger WH, Jr, Shumaker S, et al. The evaluation of pain in patients with knee osteoarthritis: the knee pain scale. J Rheumatol. 1995;22(6):1124–1129 13. Eslamian F, Amouzandeh B. Therapeutic effects of prolotherapy with intra-articular dextrose injection in patients with moderate knee osteoarthritis: a single-arm study with 6 months follow up. Therapeut Adv Musculoskel Dis. 2015; 7(2):35–44. 14. Rabago D, Zgierska A, Fortney L, Kijowski R, Mundt M, Ryan M, et al. Hypertonic dextrose injections (prolotherapy) for knee osteoarthritis: results of a single-arm uncontrolled study with 1-year follow-up. J Alternative Complement Med. 2012; 18(4):408–14. 15. Rabago D, Mundt M, Zgierska A, Grettie J. Hypertonic dextrose injection (prolotherapy) for knee osteoarthritis: long term outcomes. Complement Ther Med. 2015; 23(3):388–95. 16. Reeves KD, Hassanein K. Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity. Altern Ther Health Med. 2000; 6(2): 68–74, 77–80.17. Banks A. A rationale for prolotherapy. J Orthop Med. 1991;13(3): 54–59 18. Jensen KT, Rabago DP, Best TM, Patterson JJ, Vanderby R., Jr Early inflammatory response of knee ligaments to prolotherapy in a rat model. J Orthop Res. 2008;26(6):816–823 19. Jensen KT. Healing Response of Knee Ligaments to Prolotherapy in a Rat Model [dissertation]. Madison, WI: University of Wisconsin; 2006 20. Kim SR, Stitik TP, Foye PM, Greenwald BD, Campagnolo DI. Critical review of prolotherapy for osteoarthritis, low back pain, and other musculoskeletal conditions: a physiatric perspective. Am J Phys Med Rehabil. 2004;83(5):379–389 21. Lyftogt J. Prolotherapy and Achilles tendinopathy: a prospective pilot study of an old treatment. Australasian Musculoskeletal Medicine. 2005;10(1):16–19 22. Rabago D, Wilson JJ, Zgierska A. Platelet-rich plasma for treatment of Achilles tendinopathy. JAMA. 2010; 303(17):1696– 1697, author reply 1697–1698.