Dextrose prolotherapy for knee osteoarthritis: a randomized controlled trial

Ann Fam Med. May-Jun 2013;11(3):229-37. doi: 10.1370/afm.1504.

Abstract

Purpose: Knee osteoarthritis is a common, debilitating chronic disease. Prolotherapy is an injection therapy for chronic musculoskeletal pain. We conducted a 3-arm, blinded (injector, assessor, injection group participants), randomized controlled trial to assess the efficacy of prolotherapy for knee osteoarthritis.

Methods: Ninety adults with at least 3 months of painful knee osteoarthritis were randomized to blinded injection (dextrose prolotherapy or saline) or at-home exercise. Extra- and intra-articular injections were done at 1, 5, and 9 weeks with as-needed additional treatments at weeks 13 and 17. Exercise participants received an exercise manual and in-person instruction. Outcome measures included a composite score on the Western Ontario McMaster University Osteoarthritis Index (WOMAC; 100 points); knee pain scale (KPS; individual knee), post-procedure opioid medication use, and participant satisfaction. Intention-to-treat analysis using analysis of variance was used.

Results: No baseline differences existed between groups. All groups reported improved composite WOMAC scores compared with baseline status (P <.01) at 52 weeks. Adjusted for sex, age, and body mass index, WOMAC scores for patients receiving dextrose prolotherapy improved more (P <.05) at 52 weeks than did scores for patients receiving saline and exercise (score change: 15.3 ± 3.5 vs 7.6 ± 3.4, and 8.2 ± 3.3 points, respectively) and exceeded the WOMAC-based minimal clinically important difference. Individual knee pain scores also improved more in the prolotherapy group (P = .05). Use of prescribed postprocedure opioid medication resulted in rapid diminution of injection-related pain. Satisfaction with prolotherapy was high. There were no adverse events.

Conclusions: Prolotherapy resulted in clinically meaningful sustained improvement of pain, function, and stiffness scores for knee osteoarthritis compared with blinded saline injections and at-home exercises.

Trial registration: ClinicalTrials.gov NCT00085722.

Keywords: dextrose; knee; osteoarthritis; prolotherapy; randomized controlled trial.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Activities of Daily Living
  • Adult
  • Arthralgia / drug therapy*
  • Female
  • Glucose / administration & dosage*
  • Humans
  • Injections, Intra-Articular
  • Knee Joint / drug effects*
  • Male
  • Middle Aged
  • Osteoarthritis, Knee / drug therapy*
  • Pain Measurement
  • Range of Motion, Articular / drug effects*
  • Severity of Illness Index
  • Treatment Outcome

Substances

  • Glucose

Associated data

  • ClinicalTrials.gov/NCT00085722