Comparative effectiveness of intra-articular prolotherapy versus peri-articular prolotherapy on pain reduction and improving function in patients with knee osteoarthritis: A randomized clinical trial

Abstract

BackgroundOsteoarthritis is a common degenerative disease. Prolotherapy is an alternative therapy used in multiple musculoskeletal disorders.ObjectiveTo compare the effectiveness of intra-articular dextrose injection versus peri-articular prolotherapy in patients with knee osteoarthritis (KOA).MethodsFifty-two adults with painful primary knee osteoarthritis for at least three months were randomized to intra- and peri-articular injection groups. Prolotherapy was done twice with two week intervals. The outcome measures included the Oxford Knee Scale (OKS), Western Ontario McMaster University Osteoarthritis Index (WOMAC), and Visual Analogue Scale (VAS), which were obtained from patients before the first injection at the base line and after the second injection at the fourth and eighth weeks.ResultsThere were no statistically significant differences between demographic characteristics; before the injection, pain intensity, OKS, and WOMAC scores were approximately equal between the two groups. After dextrose prolotherapy, VAS, OKS, and WOMAC scores improved from baseline through the fourth and eighth weeks in both groups without any superiority between the two methods of injections (p<0.001).ConclusionDextrose prolotherapy either intra- or peri-articular injection resulted in significant improvement, so it could be an inexpensive and effective management of knee osteoarthritis.Trial registrationThe study protocol was registered as a clinical trial under registration ID of IRCT2016091229795N1 at the Iranian Registry of Clinical Trials (http://www.irct.ir).FundingThe authors received no financial support for the research, authorship, or publication of this article.

Prolotherapy for knee osteoarthritis using hypertonic dextrose vs other interventional treatments: systematic review of clinical trials

“…Other studies have reported similar reduction of pain and function improvement when comparing intra-articular hypertrophic dextrose vs subcutaneous dextrose; [24,25] this therapeutic effect cannot be attributed to chondrogenic mechanisms or to ligamentous or tendinous remodeling, but perhaps due to neurogenic effects. Two studies [19,20] combined intra-articular and extra-articular HDP applications on ligaments insertions and tendons and observed a long term effect.…”

“…Fortyeight studies were read in detail, then 38 were excluded for the following reasons: review studies (n = 20), other pathology interventions (n = 9), case series studies (n = 7), controlled clinical trials compared against non-interventional treatments (n = 2). Finally, 10 randomized clinical trials [17][18][19][20][21][22][23][24][25][26] were eligible for inclusion in this systematic review. The systematized flowchart search is shown in Fig.…”

“…Finally, two studies [24,25] compared intra-articular hypertonic dextrose application vs subcutaneous dextrose application, reporting that in both groups there was a statistically significant improvement in pain and function.…”

“…In relation to the length of the HDP effects when treating knee OA, we found that nine studies [18][19][20][21][22][23][24][25][26] evaluated results with a follow-up of 2-3 months and all of them reported that the beneficial effect did not end. Six studies evaluated the HDP effects at 5-6 months [17,19,20,23,26] and five of them observed that the effect lasted the whole time.…”

“…Four studies [20,21,24,26] reported that there were no side effects or adverse reactions in patients who received HDP. Two studies [17,19] reported minimal adverse reactions in both HDP treated groups and control groups, including mild to moderate pain, inflammation and selflimiting hematomas.…”