Long-term Efficacy of Dextrose Prolotherapy versus Hyaluronic Acid in Knee Osteoarthritis

Abstract

Background: Osteoarthritis (OA) is the most common form of arthritis. Management of OA includes lifestyle modification, exercise, supportive care, weight control, pharmacological treatment, intra-articular injection, and surgery. Due to little knowledge about knee prolotherapy, in this study, we investigated the efficacy of prolotherapy for knee OA compared with hyaluronic acid (HA).

Methods: In this prospective randomized blinded clinical trial, after the diagnosis of OA, the range of motion (ROM), joint line tenderness, pain intensity [visual analog scale (VAS) score], and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire were evaluated. Randomization was performed by concealed allocation using computer software. The participants, outcome assessor, physical examiner, and radiologist were blinded to injection group status. Three intra-articular injections (every month in prolotherapy
group and every week in the HA group) were performed. Patients at one week, one month, three months, eight months, and nine months after the end of treatment were re-evaluated.

Results: A total of 130 patients were screened and finally 61 patients in the HA group and 53 in the dextrose prolotherapy group completed the study. In the dextrose prolotherapy group, changes in joint ROM had an upward trend, but pain intensity and the total WOMAC score constituted a downward pattern and in the HA group, maximum improvement was achieved between 4 to 6 months after the last injection, followed by a slightly progressive worsening after 6 to 12 months. The final clinical scores remained higher compared with baseline in both groups (P < 0.001). The mean scores for all patients significantly improved (P < 0.001 for VAS and P < 0.030 for ROM) from baseline to months 6 and 12. However, dextrose prolotherapy group had a significantly greater improvement (P < 0.001) than HA group.

Conclusion: Dextrose prolotherapy showed more and longer efficacy than HA injections in reducing pain and symptoms and recovering articular function. Therefore, it can be a good choice for the treatment of knee OA.