Hypertonic Dextrose Prolotherapy, an Alternative to Intra-Articular Injections With Hyaluronic Acid in the Treatment of Knee Osteoarthritis

Abstract

Intra-articular injections with hyaluronic acid are recommended in the treatment of knee osteoarthritis; however, hypertonic dextrose prolotherapy has been reported as effective and safe. The aim was to evaluate the effectiveness of hypertonic dextrose prolotherapy for pain reduction and improvement of function in individuals with knee osteoarthritis in comparison with hyaluronic acid by meta-analysis. The search was performed in electronic databases. Six studies were included (395 participants). No statistically significant differences were found between prolotherapy and hyaluronic acid in pain control in the short-term; however, in the subanalysis that included only the studies that used intra-articular injection within the prolotherapy scheme, an effect was found in favor of the prolotherapy groups (d = −1.33; 95% confidence interval, −2.50 to −0.16; P (z) = 0.03). Also, an effect was found in favor of the prolotherapy group in the improvement in function (d = −1.05; 95% confidence interval, −2.03 to −0.08; P (z) = 0.03). No major adverse reactions or side effects were reported in any of the studies. Hypertonic dextrose prolotherapy seems to be an effective intervention to decrease pain and improve function in knee osteoarthritis, with efficacy similar to intra-articular injections with hyaluronic acid in the short-term follow-up. Nonetheless, better-quality clinical trials are necessary.

Intra-articular Injections for Treating Knee Osteoarthritis: A Classification According to Their Mechanism of Action

“…54 Clinical studies have reported the efficacy of PHD in pain control and improvement of function in KOA patients. [55][56][57] Some studies have compared PHD with IAI of CSs and reported that, in the short term, CSs are more effective in controlling pain and improving function; however, in the medium term, the result is reversed and PHD is more effective. 57 A recent meta-analysis compared the efficacy of HA injections with PHD in patients with KOA and reported equal efficacy in reducing pain and improving function at 3 months of follow-up.…”

“…57 A recent meta-analysis compared the efficacy of HA injections with PHD in patients with KOA and reported equal efficacy in reducing pain and improving function at 3 months of follow-up. 55 Prolotherapy with hypertonic dextrose has also been compared with IAI of PRP, observing no differences between the 2 interventions in pain reduction at 6 months of follow-up. 56 Prolotherapy with hypertonic dextrose has been reported to be a safe intervention, but it is not exempt from minor adverse reactions such as pain, swelling, and stiffness.…”

“…56 Prolotherapy with hypertonic dextrose has been reported to be a safe intervention, but it is not exempt from minor adverse reactions such as pain, swelling, and stiffness. 9 It has been described that minor adverse reactions are similar to other techniques such as IAI of HA 55 ; however, the PHD technique requires adequate training and experience, since it involves the injection of periarticular structures, and its inappropriate use could generate injuries to these structures. 9 Although PHD seems to be a viable intervention in patients with KOA, with predominantly antidegenerative and trophic mechanisms of action, the poor quality of the published clinical studies has weakened the evidence provided; up until now, PHD is not considered a standard treatment for KOA in international guidelines.…”

“…The mechanisms of action of these therapies seem to be related to anticatabolic and trophic effects on cartilage. These therapies generate a favorable delayed effect, maintained in medium and long terms in patients with KOA 28,55,56,61,66,67,69,71,74 ; these are not recommended for patients who require rapid resolution of exacerbated symptoms, and only HA is considered a standard treatment for patients with KOA. 4,5 Platelet-rich plasma has the disadvantage of lacking a standardized technique preparation, for there are a wide variety of products, devices, and techniques used, as well as different cell concentrations, platelet count, and cytokine concentration, resulting in wide heterogeneity and low reproducibility.…”

“…Clinical studies have reported the efficacy of PHD in pain control and improvement of function in KOA patients 55–57 . Some studies have compared PHD with IAI of CSs and reported that, in the short term, CSs are more effective in controlling pain and improving function; however, in the medium term, the result is reversed and PHD is more effective 57 .…”