Hypertonic dextrose compare with other substances for knee osteoarthritis: a meta-analysis of randomized control trial

Authors

  • N. Indra Tri Cahyadi Dr. Ben Mboi General Hospital Kupang, East Nusa Tenggara, Indonesia
  • Paul Steven Departement of Orthopaedics, dr. Ben Mboi Hospital, Kupang, East Nusa Tenggara, Indonesia

DOI:

https://doi.org/10.18203/2349-2902.isj20243988

Keywords:

Knee OA, Dextrose prolotherapy, Hyaluronic acid, Normal saline

Abstract

Background: Globally, osteoarthritis (OA) highly prevalent in the elderly more than 80% of those over 55 years old. At least 151 million people worldwide are afflicted. The knees, hips and spine are the joint areas that are most frequently affected. For the treatment of knee OA, intra-articular injection like stem cells, platelet rich plasma (PRP), and hypertonic dextrose (HD) the most used prolotherapy fluid is HD. It is widely accessible, reasonably inexpensive priced and reportedly safe. The aim of this meta-analysis is to thoroughly assess and compare the results of intra articular dextrose prolotherapy with hyaluronic acid and normal saline, with a focus on visual analog scale (VAS) and WOMAC score.

Methods: A comprehensive search was conducted across major electronic databases for relevant studies published from 2014 to 2024. Studies that compare intra articular dextrose prolotherapy with hyaluronic acid and normal saline for knee OA were included. We recorded the first author, year, study design, sample number, age, sex, Kellgren Lawrence grade, VAS and WOMAC score were extracted and analyzed using appropriate statistical methods.

Results: The initial search yielded a total of 2371 studies, of which 7 studies met the inclusion criteria, consisting of a total of 372 patients of intra articular dextrose prolotherapy with hyaluronic acid and normal saline for knee OA. It shows that there is no significant difference in VAS score between two groups (MD=-0.72, 95% CI:-1.74 to 0.31, p=0.17). There was no difference in WOMAC score between two groups.

Conclusions: Our results show that both methods provide similar outcome in pain scale and WOMAC score. More over to enhance the efficacy of prolotherapy in comparison to alternative treatments like HA or saline injections, it is suggested that a multicenter clinical trial with a larger number of participants be carried out.

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References

Apley GA, Solomon L. Apley’s System of Orthopaedics and Fractures. 10th ed. London: Hodder Arnold. 2017.

WHO. The Global Burden of Disease: 2004. Available at: http://www.who.int. Accessed on 15 September 2024.

Johnson VL, Hunter DJ. The epidemiology of osteoarthritis. Best Pract Res Clin Rheumatol. 2014;28:5-15. DOI: https://doi.org/10.1016/j.berh.2014.01.004

Fonsi M, El Amrani AI, Gervais F, Vincent V. Intra-articular hyaluronic acid and chondroitin sulfate: pharmacokinetic investigation in osteoarthritic rat models. Curr Ther Res Clin Exp. 2020;92:100573. DOI: https://doi.org/10.1016/j.curtheres.2019.100573

Reeves KD, Sit RWS, Rabago DP. Dextrose prolotherapy: a narrative review of basic science, clinical research, and best treatment recommendations. Phys Med Rehabil Clin N Am. 2016;27(4):783-823. DOI: https://doi.org/10.1016/j.pmr.2016.06.001

Goswami A. Prolotherapy. J Pain Palliat Care Pharmacother. 2012;26(4):376-8. DOI: https://doi.org/10.3109/15360288.2012.734900

DeChellis DM, Cortazzo MH. Regenerative medicine in the feld of pain medicine: prolotherapy, platelet-rich plasma, and stem cell therapy-theory and evidence. Tech Reg Anesth Pain Manag. 2011;15(2):74-80. DOI: https://doi.org/10.1053/j.trap.2011.05.002

Rabago D, Slattengren A, Zgierska A. Prolotherapy in primary care practice. Prim Care. 2010;37(1):65-80. DOI: https://doi.org/10.1016/j.pop.2009.09.013

Moher D, Liberati A, Tetzlaf J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535. DOI: https://doi.org/10.1136/bmj.b2535

Eroglu A, Sari A, Durmus B. Platelet-rich plasma vs prolotherapy in the management of knee osteoarthritis: randomized placebo-controlled trial. Spor Hekimligi Dergisi. 2016;51(2):34e43. DOI: https://doi.org/10.5152/tjsm.2016.005

Ramapati Sanyal, Subrata Goswami, Santi Ranjan Dasgupta, Sagarmoy Basu. Comparative study of intra articular hyaluronic acid and intra articular and paraarticular dextrose prolotherapy in mild to moderate knee osteoarthrosis. Int J Contemporary Med Res. 2018;5(1):20-23.

Hosseini B, Taheri M, Pourroustaei Ardekani R, Siamak M, Morteza KM. Periarticular hypertonic dextrose vs intraarticular hyaluronic acid injections: a comparison of two minimally invasive techniques in the treatment of symptomatic knee osteoarthritis. Open Access Rheumatol. 2019;11:269e274. DOI: https://doi.org/10.2147/OARRR.S215576

Sert AT, Sen EI, Esmaeilzadeh S, Emel O. The efects of dextrose prolotherapy in symptomatic knee osteoarthritis: a randomized controlled study. J Altern Complement Med. 2020;26:409-17. DOI: https://doi.org/10.1089/acm.2019.0335

Waluyo Y, Budu B, Adnan A, Darjanti E, Haryadi R, Idris I, et al. Changes in levels of cartilage oligomeric proteinase and urinary C-terminal telopeptide of type II collagen in subjects with knee osteoarthritis after dextrose prolotherapy: A randomized controlled trial. J Rehabilitation Med. 2021;53(5):1-7. DOI: https://doi.org/10.2340/16501977-2835

Babaeian Z, Farpour HR, Mostaghni E, Vasaghi A, Nasiri A, Arjmand H. A Comparative Study of Short-Term Efficacy of Intra-articular Hypertonic Saline and Hypertonic Dextrose Prolotherapy in Knee Osteoarthritis: A Randomized Controlled Trial (RCT). JRSR. 2022;9(2):60-64.

Rezasoltani Z, Ensieh T, Seyed MT, Sharif N, Sirous A. The Effect of Intra-articular Injection of Hypertonic Saline Versus Dextrose Prolotherapy for Knee Osteoarthritis. Ann Mil Health Sci Res. 2024;22(2):e146633. DOI: https://doi.org/10.5812/amh-146633

Hauser RA, Lackner JB, Steilen‐Matias D, Harris DK. A systematic review of dextrose prolotherapy for chronic musculoskeletal pain. Clin Med Insights Arthritis Musculoskeletal Disorder. 2016;9:139‐59. DOI: https://doi.org/10.4137/CMAMD.S39160

Rabago D, Patterson JJ, Mundt M, Richard K, Jessica G, Neil AS, et al. Dextrose prolotherapy for knee osteoarthritis: a randomized controlled trial. Ann Fam Med. 2013;11(3):229‐37. DOI: https://doi.org/10.1370/afm.1504

Arias‐Vázquez PI, Tovilla‐Zárate CA, Castillo‐Avila RG, Blanca GLR, María LLN, Russell AN, et al. Hypertonic dextrose prolotherapy, an alternative to intra‐articular injections with hyaluronic acid in the treatment of knee osteoarthritis: systematic review and meta‐analysis. Am J Phys Med Rehabilation. 2022;101(9):816‐25. DOI: https://doi.org/10.1097/PHM.0000000000001918

Rabago D, Nourani B. Prolotherapy for osteoarthritis and tendinopathy: a descriptive review. Curr Rheumatol Rep. 2017;19(6):34. DOI: https://doi.org/10.1007/s11926-017-0659-3

Parisi S, Ditto MC, Priora M, Richard B, Angela L, Clara LP, et al. Ultrasound-guided intra-articular injection: efficacy of hyaluronic acid compared to glucocorticoid in the treatment of knee osteoarthritis. Minerva Med. 2019;110(6):515-23. DOI: https://doi.org/10.23736/S0026-4806.19.06190-1

Han Y, Huang H, Pan J, Jiongtong L, Lingfeng Z, Guihong L, et al. Meta-analysis comparing platelet-rich plasma vs hyaluronic acid injection in patients with knee osteoarthritis. Pain Med. 2019;20(7):1418-29. DOI: https://doi.org/10.1093/pm/pnz011

Li Q, Qi X, Zhang Z. Intra-articular oxygen-ozone versus hyaluronic acid in knee osteoarthritis: a meta-analysis of randomized controlled trials. Int J Surg. 2018;58:3-10. DOI: https://doi.org/10.1016/j.ijsu.2018.08.007

Saltzman BM, Leroux T, Meyer MA, Basques BA, Chahal J, Bach BR Jr, et al. Cole. The Therapeutic Effect of Intra-articular Normal Saline Injections for Knee Osteoarthritis. Am J Sports Med. 2017;45(11):2647-53. DOI: https://doi.org/10.1177/0363546516680607

Wee TC, Neo EJR, Tan YL. Dextrose prolotherapy in knee osteoarthritis: a systematic review and meta‐analysis. J Clin Orthop Trauma. 2021;19:108‐17. DOI: https://doi.org/10.1016/j.jcot.2021.05.015

Khateri S, Nejad FB, Kazemi F, et al. The effect of dextrose prolotherapy on patients diagnosed with knee osteoarthritis: a comprehensive systematic review and meta‐analysis of interventional studies. Health Sci Rep. 2024;7:e2145. DOI: https://doi.org/10.1002/hsr2.2145

Wang J, Liang J, Jin Y, Hai XS, Xiao TY, Fang CW, et al. Meta analysis of clinical trials focusing on hypertonic dextrose prolotherapy (HDP) for knee osteoarthritis. Aging Clin Experimental Res. 2021;34(4):715-24. DOI: https://doi.org/10.1007/s40520-021-01963-3

Arias‐Vázquez PI, Tovilla‐Zárate CA, Legorreta‐Ramírez BG. Prolotherapy for knee osteoarthritis using hypertonic dextrose vs other interventional treatments: systematic review of clinical trials. Adv Rheumatol. 2019;59(1):39. DOI: https://doi.org/10.1186/s42358-019-0083-7

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Published

2024-12-28

How to Cite

Tri Cahyadi, N. I., & Steven, P. (2024). Hypertonic dextrose compare with other substances for knee osteoarthritis: a meta-analysis of randomized control trial. International Surgery Journal, 12(1), 72–79. https://doi.org/10.18203/2349-2902.isj20243988

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Section

Meta-Analysis