Document Type : Original Articles
Department of physical medicine and rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran.
Bone and Joint Diseases Research Center, department of physical medicine and rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran.
Shiraz Geriatric Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
department of physical medicine and rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran.
Background: Knee osteoarthritis (KOA) is a common public health disease with an increasing prevalence. It is one of the leading causes of disability, especially in the elderly. Intra-articular hypertonic dextrose prolotherapy is one of the therapies used for KOA. There have been some articles indicating that patients receiving intra-articular normal saline as a control group of the article had improvement as well. The aim of this randomized clinical trial study was to evaluate the efficacy of intra-articular hypertonic saline in comparison with hypertonic dextrose prolotherapy in treatment of KOA.
Methods: A total of 54 patients with KOA were randomized in two groups: hypertonic dextrose (28 patients) and hypertonic saline groups (26 patients). All patients received three intra-articular injections of either hypertonic dextrose or hypertonic saline at two weeks intervals. The values obtained by visual analogue pain scale (VAS), Oxford knee scale (OKS), and Western Ontario McMaster University Osteoarthritis Index (WOMAC) questionnaire were the outcome measures which were evaluated before, as well as 2 and 4 weeks after the injections. The data were analyzed using t-test and repeated measurement tests.
Results: Both groups revealed improvements in outcome measures after 2 and 4 weeks of intervention. However, no statistically significant difference was found between the two groups.
Conclusion: We concluded that the intra-articular injection of hypertonic dextrose and hypertonic saline are both effective in the management of KOA. Hypertonic saline can be considered as another medical agent in management of KOA. However, further studies are suggested to evaluate its long-term effects.
- W. Sit et al., "Hypertonic dextrose injections (prolotherapy) in the treatment of symptomatic knee osteoarthritis: a systematic review and meta-analysis," Scientific reports, 2016, vol. 6, p. 25247.
- R. Farpour and F. Fereydooni, "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," Electronic Physician, 2017, vol. 9, no. 11, p. 5663.
- W. Bijlsma, F. Berenbaum, and F. P. Lafeber, "Osteoarthritis: an update with relevance for clinical practice," The Lancet, 2011, vol. 377, no. 9783, pp. 2115-2126.
- M. Martsynyak, S. P. Chornobai, Y. L. Holyuk, and G. G. Bondariev, "Modern Approach to Conservative Treatment of Degenerative Diseases of Joints Using Regenerative Medicine Techniques," Problems of Cryobiology and Cryomedicine, 2018, vol. 28, no. 1, pp. 79-83.
- R. Farpour, F. Estakhri, M. Zakeri, and R. Parvin, "Efficacy of Piroxicam Mesotherapy in Treatment of Knee Osteoarthritis: A Randomized Clinical Trial," Evidence-Based Complementary and Alternative Medicine, 2020, vol. 2020, p. 6940741.
- A. Hauser, J. B. Lackner, D. Steilen-Matias, and D. K. Harris, "A systematic review of dextrose prolotherapy for chronic musculoskeletal pain," Clinical medicine insights: Arthritis and musculoskeletal disorders, 2016, vol. 9, p. CMAMD. S39160.
- Trescot, "Everything old is new again: New developments in prolotherapy," Techniques in Regional Anesthesia and Pain Management, 2015, vol. 19, no. 1-2, pp. 14-18.
- Rabago et al., "Dextrose and morrhuate sodium injections (prolotherapy) for knee osteoarthritis: a prospective open-label trial," The Journal of Alternative and Complementary Medicine, 2014, vol. 20, no. 5, pp. 383-391.
- D. Fullerton, "High-resolution ultrasound and magnetic resonance imaging to document tissue repair after prolotherapy: a report of 3 cases," Archives of physical medicine and rehabilitation, 2008, vol. 89, no. 2, pp. 377-385.
- J. Yelland, P. P. Glasziou, N. Bogduk, P. J. Schluter, and M. McKernon, "Prolotherapy injections, saline injections, and exercises for chronic low-back pain: a randomized trial," Spine, 2004, vol. 29, no. 1, pp. 9-16.
- D. Reeves and K. Hassanein, "Randomized, prospective, placebo-controlled double-blind study of dextrose prolotherapy for osteoarthritic thumb and finger (DIP, PIP, and trapeziometacarpal) joints: evidence of clinical efficacy," The Journal of Alternative & Complementary Medicine, 2000, vol. 6, no. 4, pp. 311-320.
- Rabago et al., "Association between disease-specific quality of life and magnetic resonance imaging outcomes in a clinical trial of prolotherapy for knee osteoarthritis," Archives of physical medicine and rehabilitation, 2013, vol. 94, no. 11, pp. 2075-2082.
- A. Hauser, M. A. Hauser, and N. M. Baird, "Evidence-based use of dextrose prolotherapy for musculoskeletal pain: A scientific literature review," J Prolotherapy, 2011, vol. 3, no. 4, pp. 765-789.
- Kellgren and J. Lawrence, "Radiological assessment of osteo-arthrosis," Annals of the rheumatic diseases, 1957, vol. 16, no. 4, p. 494.
- Refai, O. Altahhan, and R. Elsharkawy, "The efficacy of dextrose prolotherapy for temporomandibular joint hypermobility: a preliminary prospective, randomized, double-blind, placebo-controlled clinical trial," Journal of Oral and Maxillofacial Surgery, 2011, vol. 69, no. 12, pp. 2962-2970.
- D. Reeves and K. Hassanein, "Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity," Alternative therapies in health and medicine, 2000, vol. 6, no. 2, pp. 68-80.
- W. Sit et al., "Hypertonic dextrose injections (prolotherapy) in the treatment of symptomatic knee osteoarthritis: a systematic review and meta-analysis," Scientific reports, 2016, vol. 6, no. 1, pp. 1-12.
- M. Saltzman et al., "The therapeutic effect of intra-articular normal saline injections for knee osteoarthritis: a meta-analysis of evidence level 1 studies," The American journal of sports medicine, 2017, vol. 45, no. 11, pp. 2647-2653.
- r. Farpour, A. Ashraf, and S. S. Hosseini, "The Efficacy of Ozone Prolotherapy Compared to Intra-Articular Hypertonic Saline Injection in Reducing Pain and Improving the Function of Patients with Knee Osteoarthritis: A Randomized Clinical Trial," Evidence-Based Complementary and Alternative Medicine, 2021 Aug 3;2021.
- Tavana, S. Azizi, S. Najafi, E. Taftian, and N. Maghbouli, "The Effectiveness of Intra-Articular Injection of Hypertonic Saline in Pain Control and Function of Patients with Knee Osteoarthritis," Journal of Orthopedic and Spine Trauma, 2020 Jun 20.