Skip to main content

Advertisement

SpringerLink
Log in

A comparative analysis of prolotherapy efficacy in patients with knee osteoarthritis across varied dextrose concentrations

  • ORIGINAL ARTICLE
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Objective

To compare the effectiveness of prolotherapy with dextrose concentrations of 5%, 10%, and 20% in patients diagnosed with knee osteoarthritis.

Methods

This study was planned as a prospective, randomized controlled interventional trial. Prolotherapy at 5% dextrose concentration in group 1, 10% in group 2, and 20% in group 3 was applied to the knee intra-articularly and periarticularly at 0, 3, and 6 weeks, and a home exercise program was given. Group 4 received a home exercise program. All groups received hotpack therapy at weeks 0, 3, and 6. Outcome measures included the visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), knee range of motion, timed up and go test, and Short Form-36.

Results

A total of 128 patients were divided into 4 groups. At the 6th and 12th weeks, VAS scores were significantly lower in groups 2 and 3 than in group 4 (p < 0.05). At the 12th week, the WOMAC pain score was significantly lower in group 3 than in group 4, and WOMAC physical function and WOMAC total scores were significantly lower in groups 1, 2, and 3 than in group 4 (p < 0.05). Week 6 active and passive knee flexion and week 12 passive knee flexion were significantly higher in group 3 than in group 4 (p < 0.05).

Conclusions

Although no significant difference was observed among the dextrose prolotherapy groups, higher dextrose concentrations demonstrated a greater improvement compared to the control group. Therefore, the use of 20% dextrose is recommended due to its significant superiority. Long-term follow-up and placebo-controlled studies are needed.

Trial registration

ClinicalTrial.gov Identifier: NCT05537077, registration date: 09.03.2022, retrospectively registered.

Key Points

• The utilization of dextrose prolotherapy has gained popularity in the management of osteoarthritis, aiming to harness its regenerative and proliferative properties. However, the comparative efficacy of various concentrations of dextrose prolotherapy in treating knee osteoarthritis remains unexplored in the literature. This study aimed to address this gap by comparing different concentrations of dextrose prolotherapy in the treatment of knee osteoarthritis. The findings revealed no statistically significant difference among the various concentrations of dextrose prolotherapy for knee osteoarthritis treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data Availability

Authors may share data on reasonable request.

References

  1. Cross M, Smith E, Hoy D, Nolte S, Ackerman I, Fransen M et al (2014) The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis 73(7):1323–1330. https://doi.org/10.1136/annrheumdis-2013-204763

    Article  PubMed  Google Scholar 

  2. Hsu H, Siwiec RM (2022) Knee Osteoarthritis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan

  3. Lespasio MJ, Piuzzi NS, Husni ME, Muschler GF, Guarino A, Mont MA (2017) Knee Osteoarthritis: A Primer. Perm J 21:16–183. https://doi.org/10.7812/TPP/16-183

    Article  PubMed  Google Scholar 

  4. Sharma L (2021) Osteoarthritis of the knee. N Engl J Med 384(1):51–59. https://doi.org/10.1056/NEJMcp1903768

    Article  CAS  PubMed  Google Scholar 

  5. Wu Y, Zhu F, Chen W, Zhang M (2022) Effects of transcutaneous electrical nerve stimulation (TENS) in people with knee osteoarthritis: a systematic review and meta-analysis. Clin Rehabil 36(4):472–485. https://doi.org/10.1177/02692155211065636

    Article  PubMed  Google Scholar 

  6. Bączkowicz D, Skiba G, Czerner M, Majorczyk E (2018) Gait and functional status analysis before and after total knee arthroplasty. Knee 25(5):888–896. https://doi.org/10.1016/j.knee.2018.06.004

    Article  PubMed  Google Scholar 

  7. Wee TC, Neo EJR, Tan YL (2021) Dextrose prolotherapy in knee osteoarthritis: a systematic review and meta-analysis. J Clin Orthop Trauma 19:108–117. https://doi.org/10.1016/j.jcot.2021.05.015

    Article  PubMed  PubMed Central  Google Scholar 

  8. Hassan F, Trebinjac S, Murrell WD, Maffulli N (2017) The effectiveness of prolotherapy in treating knee osteoarthritis in adults: a systematic review. Br Med Bull 122(1):91–108. https://doi.org/10.1093/bmb/ldx006

    Article  PubMed  Google Scholar 

  9. Bernetti A, Agostini F, Alviti F, Giordan N, Martella F, Santilli V et al (2021) New viscoelastic hydrogel hymovis MO. RE. Single intra-articular injection for the treatment of knee osteoarthritis in sportsmen: safety and efficacy study results. Front Pharmacol 12:673988. https://doi.org/10.3389/fphar.2021.673988

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Bae G, Kim S, Lee S, Lee WY, Lim Y (2021) Prolotherapy for the patients with chronic musculoskeletal pain: systematic review and meta-analysis. Anesth Pain Med 16(1):81–95. https://doi.org/10.17085/apm.20078

    Article  Google Scholar 

  11. Rhatomy S, Margaretha E, Rahmadian R (2020) Dextrose prolotherapy for muscle, tendon and ligament injury or pathology: a systematic review. Ann Res Rev Biol 35(10):43–62. https://doi.org/10.9734/arrb/2020/v35i1030288

    Article  Google Scholar 

  12. Akpancar S, Murat Seven M, Yasin Tuzun H, Gurer L, Ekinci S (2017) Current concepts of prolotherapy in orthopedic surgery. Arch Trauma Res 6(2):1–9. https://doi.org/10.5812/ATR.40447

    Article  Google Scholar 

  13. Hauser RA, Lackner JB, Steilen-Matias D, Harris DK (2016) A systematic review of dextrose prolotherapy for chronic musculoskeletal pain. Clin Med Insights: Arthritis Musculoskelet Disord 9:CMAMD. S39160. https://doi.org/10.4137/CMAMD.S39160

    Article  Google Scholar 

  14. Sit RWS, Wu RWK, Reeves KD, Rabago D, Chan DCC, Yip BHK et al (2018) Efficacy of intra-articular hypertonic dextrose prolotherapy versus normal saline for knee osteoarthritis: a protocol for a triple-blinded randomized controlled trial. BMC Complement Altern Med 18:1–8. https://doi.org/10.1186/s12906-018-2226-5

    Article  Google Scholar 

  15. Dalton JA, McNaull F (1998) A call for standardizing the clinical rating of pain intensity using a 0 to 10 rating scale. Cancer Nurs 21(1):46–49. https://doi.org/10.1097/00002820-199802000-00006

    Article  CAS  PubMed  Google Scholar 

  16. Basaran S, Guzel R, Seydaoglu G, Guler-Uysal F (2010) Validity, reliability, and comparison of the WOMAC osteoarthritis index and Lequesne algofunctional index in Turkish patients with hip or knee osteoarthritis. Clin Rheumatol 29:749–756. https://doi.org/10.1007/s10067-010-1398-2

    Article  PubMed  Google Scholar 

  17. Podsiadlo D, Richardson S (1991) The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39(2):142–148. https://doi.org/10.1111/j.1532-5415.1991.tb01616.x

    Article  CAS  PubMed  Google Scholar 

  18. Ware Jr JE, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Med Care 30(6):473–83

  19. Güran Ş, Çoban ZD, Karasimav Ö, Demirhan S, Karaağaç N, Örsçelik A et al (2018) Dextrose solution used for prolotherapy decreases cell viability and increases gene expressions of angiogenic and apopitotic factors. Gulhane Med J 60(2):42–46

    Article  Google Scholar 

  20. Billesberger LM, Fisher KM, Qadri YJ, Boortz-Marx RL (2020) Procedural treatments for knee osteoarthritis: a review of current injectable therapies. Pain Res Manag 3873098. https://doi.org/10.1155/2020/3873098

  21. Farpour HR, Fereydooni F (2017) 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. Electron Physician 9(11):5663. https://doi.org/10.19082/5663

    Article  PubMed  Google Scholar 

  22. Rezasoltani Z, Taheri M, Mofrad MK, Mohajerani SA (2017) Periarticular dextrose prolotherapy instead of intra-articular injection for pain and functional improvement in knee osteoarthritis. J Pain Res 10:1179–87. https://doi.org/10.2147/JPR.S127633

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Chen Y-W, Lin Y-N, Chen H-C, Liou T-H, Liao C-D, Huang S-W (2022) Effectiveness, compliance, and safety of dextrose prolotherapy for knee osteoarthritis: a meta-analysis and metaregression of randomized controlled trials. Clin Rehabil 36(6):740–752. https://doi.org/10.1177/02692155221086213

    Article  PubMed  Google Scholar 

  24. Sit RW, Chung VC, Reeves KD, Rabago D, Chan KK, Chan DC et al (2016) Hypertonic dextrose injections (prolotherapy) in the treatment of symptomatic knee osteoarthritis: a systematic review and meta-analysis. Sci Rep 6(1):25247. https://doi.org/10.1038/srep25247

    Article  CAS  PubMed Central  Google Scholar 

  25. Maniquis-Smigel L, Dean Reeves K, Jeffrey Rosen H, Lyftogt J, Graham-Coleman C, Cheng AL et al (2017) Short term analgesic effects of 5% dextrose epidural injections for chronic low back pain: a randomized controlled trial. Anesth Pain Med 7(1):e42550. https://doi.org/10.5812/aapm.42550

    Article  PubMed  Google Scholar 

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

    Article  Google Scholar 

  27. Topol GA, Podesta LA, Reeves KD, Giraldo MM, Johnson LL, Grasso R et al (2016) Chondrogenic effect of intra-articular hypertonic-dextrose (prolotherapy) in severe knee osteoarthritis. PM&R 8(11):1072–1082. https://doi.org/10.1016/j.pmrj.2016.03.008

    Article  Google Scholar 

  28. Sert AT, Sen EI, Esmaeilzadeh S, Ozcan E (2020) The effects of dextrose prolotherapy in symptomatic knee osteoarthritis: a randomized controlled study. J Altern Complement Med 26(5):409–417. https://doi.org/10.1089/acm.2019.0335

    Article  PubMed  Google Scholar 

  29. Rabago D, Patterson JJ, Mundt M, Kijowski R, Grettie J, Segal NA et al (2013) Dextrose prolotherapy for knee osteoarthritis: a randomized controlled trial. Ann Family Med 11(3):229–237. https://doi.org/10.1370/afm.1504

    Article  Google Scholar 

  30. Dumais R, Benoit C, Dumais A, Babin L, Bordage R, de Arcos C et al (2012) Effect of regenerative injection therapy on function and pain in patients with knee osteoarthritis: a randomized crossover study. Pain Med 13(8):990–999. https://doi.org/10.1111/j.1526-4637.2012.01422.x

    Article  PubMed  Google Scholar 

  31. Reeves KD, Hassanein K (2000) Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity. Altern Ther Health Med 6(2):68–80

    CAS  PubMed  Google Scholar 

  32. Soliman D, Sherif N, Omar O, El Zohiery A (2016) Healing effects of prolotherapy in treatment of knee osteoarthritis healing effects of prolotherapy in treatment of knee osteoarthritis. Egypt Rheumatol Rehabil 43:47–52. https://doi.org/10.4103/1110-161X.181858

    Article  Google Scholar 

  33. Mustafa R, Güngörmüs M, Mollaoglu N (2018) Evaluation of the efficacy of different concentrations of dextrose prolotherapy in temporomandibular joint hypermobility treatment. J Craniofac Surg 29(5):e461–e465. https://doi.org/10.1097/SCS.0000000000004480

    Article  PubMed  Google Scholar 

  34. Ciftci YGD, Tuncay F, Kocak FA, Okcu M (2023) Is low-dose dextrose prolotherapy as effective as high-dose dextrose prolotherapy in the treatment of lateral epicondylitis? A double-blind, ultrasound guided, randomized controlled study. Arch Phys Med Rehabil 104(2):179–187. https://doi.org/10.1016/j.apmr.2022.09.017

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Atatürk University, Erzurum, Turkey

    Muhammet Uğur Öztürk & Fatih Baygutalp

Authors
  1. Muhammet Uğur Öztürk
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fatih Baygutalp
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Conceptualization, data curation, funding acquisition, methodology, investigation, project administration, resources, visualization, and writing—original draft were performed by Muhammet Uğur Öztürk. Formal analysis, supervision, software, validation, writing—review, and editing were performed by Fatih Baygutalp. The first draft of the manuscript was written by Muhammet Uğur Öztürk. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Muhammet Uğur Öztürk.

Ethics declarations

Ethical statement

The Atatürk University Faculty of Medicine Ethics Committee approved this study on February 27, 2020 (No: B.30.2ATA.0.01.00/104). The study was uploaded to Clinicaltrials.gov and received the ID code NCT05537077. This study was conducted in accordance with the principles of the Declaration of Helsinki.

Informed consent

After being informed about the study, written informed consent forms were acquired from each patient.

Disclosures

None.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Öztürk, M.U., Baygutalp, F. A comparative analysis of prolotherapy efficacy in patients with knee osteoarthritis across varied dextrose concentrations. Clin Rheumatol 42, 3321–3331 (2023). https://doi.org/10.1007/s10067-023-06723-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-023-06723-4

Keywords

Search

Navigation