Researchers Compare Prolotherapy for OA Knee Pain vs. Local Anesthetics

Is prolotherapy more effective at treating knee pain caused by osteoarthritis than traditional interventional treatments such as local anesthetics, hyaluronic acid, ozone and radiofrequency?

One study published last August in Advances in Rheumatology suggests that it has significant benefits, though further research is needed.

The study was conducted by Pedro Iván Arias-Vázquez, Carlos Alfonso Tovilla-Zárate, Blanca Gabriela Legorreta-Ramírez, Wajid Burad Fonz, Dory Magaña-Ricardez, Thelma Beatriz González-Castro, Isela Esther Juárez-Rojop and María Lilia López-Narváez.

The scientists concluded:

“In terms of pain reduction and function improvement, prolotherapy with hypertonic dextrose was more effective than infiltrations with local anesthetics, as effective as infiltrations with hyaluronic acid, ozone or radiofrequency and less effective than PRP and erythropoietin, with beneficial effects in the short, medium and long term. In addition, no side effects or serious adverse reactions were reported in patients treated with hypertonic dextrose. Although HDP seems to be a promising interventional treatment for knee OA, more studies with better methodological quality and low risk of bias are needed to confirm the efficacy and safety of this intervention.”

A Departure from Conventional Treatment for OA Knee Pain

The research looks promising, though few doctors currently use prolotherapy to treat osteoarthritis.

“I would not recommend prolotherapy because I believe the jury is still out on its efficacy,” says Julius Oni, MD, assistant professor of orthopedic surgery at Johns Hopkins University School of Medicine in Baltimore, Maryland. “Most studies in the treatment of osteoarthritis are relatively small and show some short-term benefit, with no definitive mid-term or long-term benefit.”

Prolotherapy, also known as hypertonic dextrose injection, is an injection-based treatment used for many painful chronic musculoskeletal pain conditions, including osteoarthritis. The therapy involves injecting relatively small volumes (0.5–6 ml) of an irritant solution, usually hypertonic dextrose, at painful ligament and tendon attachments, as well as in adjacent joint spaces.

Prolotherapy vs. PRP or Platelet-rich-plasma Treatment

Prolotherapy differs from platelet-rich-plasma treatment, otherwise known as PRP treatment, in that it injects dextrose, or sugar water, to create inflammation in the painful tendon, muscle, joint, or ligament. PRP injects the patient’s own plasma — the part of the blood containing growth factors recognized to promote healing. Prolotherapy works more slowly — requiring 4 to 8 or more injections, whereas PRP works faster, taking only 2 to 4 injections typically.

The systematic review included 10 randomized clinical trials. The total sample size comprised 328 patients treated with hypertonic dextrose (prolotherapy) vs 348 controls treated with other infiltrations such as local anesthetics, hyaluronic acid, ozone, platelet-rich plasma or interventional procedures like radiofrequency.

Research Methods

These trials compared the effect of intra-articular and / or extra-articular infiltrations of hypertonic dextrose vs the effect of intra-articular and / or extra-articular infiltrations of other substances or some interventional procedure application, via assessing pain, physical function and secondary effects and / or adverse reactions.

Researchers searched for randomized clinical trials that evaluated therapeutic interventions in patients with knee osteoarthritis in electronic databases including PUBMED, SCIELO, DIALNET and Google Scholar.

Scientists used methodology based on the PRISMA statement for systematic review and meta-analysis type reports presentation.

The review included Randomized Controlled Clinical Trials that used a therapeutic intervention with HDP vs other substances infiltration or some other performance interventional procedure for treating patients with knee OA. Researchers specifically excluded any reviews, series of cases studies, reports of one case, randomized clinical trials performed in patients with knee OA that compared non-interventional treatments and studies performed for knee pathologies other than OA.

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