Intra-articular hypertonic dextrose injections marginally improve pain and function in patients with knee osteoarthritis

Reference

Sit RWS, Wu RWK, Rabago D, et al. Efficacy of intra-articular hypertonic dextrose (prolotherapy) for knee osteoarthritis: a randomized controlled trial. Ann Fam Med 2020;18(3):235-242.

Synopsis

These authors recruited patients with confirmed degenerative joint disease (DJD) of the knee and moderately severe pain who attended a university primary care clinic in Hong Kong. Most studies of prolotherapy use a 25% dextrose solution injected both intra- and extra-articularly. In this study, the authors randomized patients to receive intra-articular injections of hypertonic dextrose (5 mL 25% dextrose; n = 38) or normal saline (5 mL; n = 38) at 0, 4, 8, and 16 weeks. The researchers evaluated each patient using a variety of standardized scales and clinical measures. The participants were an average of 63.2 years of age, 71% were female, 21% were overweight, and 46% were obese. After 1 year, the patients who received prolotherapy had a greater degree of improvement in the overall Western Ontario McMaster University Osteoarthritis Index (WOMAC) and its various subscales. Most of the improvements occurred before 16 weeks. However, the net differences were in the range of 10 points, which is below the minimal clinically important difference for the WOMAC. Two patients who received prolotherapy and 6 patients who received saline reported unspecified serious adverse events.