Comparative Study of Intra Articular Hyaluronic Acid and Intra Articular and Para Articular Dextrose Prolotherapy in Mild to Moderate Knee Osteoarthrosis (original) (raw)
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Open Access Rheumatology: Research and Reviews, 2019
Background: Knee osteoarthritis (KOA) is the most prevailing form of joint disease. Despite the importance of minimally invasive therapeutic methods of KOA, there is a lack of evidence to compare intraarticular hyaluronic acid injection vs traditional dextrose prolotherapy. Objective: The aim was to compare the therapeutic effects of prolotherapy with hypertonic dextrose vs hyaluronic acid on function and pain in KOA cases. Materials and methods: One hundred and four KOA patients were enrolled and randomly assigned into two groups, each containing 52 patients. The hyaluronic acid (HA) group were treated by 2.5 mL of hyaluronic acid intraarticulary, and the hypertonic dextrose (HD) group received 10 mL of 12.5% dextrose periarticulary. Injections were repeated three times with 1week intervals. Pain intensity, measured by visual analog scale, and knee function, scaled by the Western Ontario and McMaster university arthritis index scores were compared between the two groups before and 3 months after intervention. Pain and function of the knee improved significantly (P<0.001) in all patients. However, significantly more symptom relief was found in the HA over the HD group. Prolotherapy with hypertonic dextrose and intraarticular injection of hyaluronic acid results in the same pain reduction and symptom relief as a noninvasive therapeutic method of KOA. Conclusion: These results recommended intraarticular hyaluronic acid rather than prolotherapy by hypertonic dextrose for KOA symptoms relief.
Introduction: Osteoarthritis (OA) is the most prevalent chronic joint disorder worldwide and is associated with significant pain and disability. The introduction of 25% Dextrose injection has been viewed as an advance in the management of OA knee. Methods: A prospective, randomized clinical trial was conducted with 84 cases in the Physical Medicine and Rehabilitation (PMR) department of BSMMU. Group A, 42 patients received single dose 25% Dextrose injection intra articular 8ml, exercise and ADL; Group B, 42 patients received exercise and ADL. Outcomes were measured by OA specific translated and validated Bengali instrument-Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire and visual analogue scale (VAS 0-10). They were followed up for 6 months. Result: At the initial stage and in week 4, there was no statistical difference between two groups regarding VAS score (as p value was >0.05). But in week 12 and 24, there was highly significant statistical difference regarding VAS score between two groups as the p value was <0.001. Again at the initial stage and week 4, there was no statistical difference between two groups regarding stiffness and physical function score. But in week 12 and 24, there was significant statistical difference regarding stiffness and physical function score between two groups as the p value was less than 0.05. Conclusion: Intra-articular injection of 25% dextrose administered to patients with OA knee has significant effects in pain reduction and functional improvement.
The Journal of Alternative and Complementary Medicine, 2012
Objective: The objective of this study was to determine whether prolotherapy, an injection-based complementary treatment for chronic musculoskeletal conditions, improves pain, stiffness, and function in adults with symptomatic knee osteoarthritis (KOA) compared to baseline status. Design: This was a prospective, uncontrolled study with 1-year follow-up. Setting: The study was conducted in an outpatient setting. Participants: Adults with at least 3 months of symptomatic KOA, recruited from clinical and community settings, participated in the study. Interventions: Participants received extra-articular injections of 15% dextrose and intra-articular prolotherapy injections of 25% dextrose at 1, 5, and 9 weeks, with as-needed treatments at weeks 13 and 17. Outcome measures: Primary outcome measure was the validated Western Ontario McMaster University Osteoarthritis Index (WOMAC). Secondary outcome measure was the validated Knee Pain Scale (KPS). Tertiary outcome measure was procedure-related pain severity and participant satisfaction. Results: Thirty-six (36) participants (60 -8.7 years old, 21 female) with moderate-to-severe KOA received an average of 4.3 -0.7 prolotherapy injection sessions over a 17-week treatment period and reported progressively improved scores during the 52-week study on WOMAC and KPS measures. Participants reported overall WOMAC score improvement 4 weeks after the first injection session (7.6 -2.4 points, 17.2%), and continued to improve through the 52-week follow-up (15.9 -2.5 points, p < 0.001, 36.1%). KPS scores improved in both injected ( p < 0.001) and uninjected knees ( p < 0.05). Prescribed low-dose opioid analgesia effectively treated procedurerelated pain. Satisfaction was high and there were no adverse events. Female gender, age 46-65 years old, and body-mass index of 25 kg/m 2 or less were associated with greater improvement on the WOMAC instrument. Conclusions: In adults with moderate to severe KOA, dextrose prolotherapy may result in safe, significant, sustained improvement of knee pain, function, and stiffness scores. Randomized multidisciplinary effectiveness trials including evaluation of potential disease modification are warranted to further assess the effects of prolotherapy for KOA.
Romanian Journal of Physical Therapy, 2022
Introduction: Intra-articular Hyaluronic acid (IAHA) injection provides intra-articular (IA) anti-inflammatory effect and improves synovial fluid flow dynamics and viscoelasticity. The aim of this prospective observational, clinical study was to evaluate the safety and efficacy of Hyaluronic Acid (HA) (40mg/2ml) 3 times with one week interval for the treatment of osteoarthritis (OA). Methods and materials: A total of 105 adults with OA were enrolled in the study. Each patient received 3 injection cycles of HA with one week interval. WOMAC OA Index was used to assess the effectiveness of injection and SF-36 to observe the change in quality of life. Physical examination was performed before injection and at the 3rd and 6th months following injection. Results: WOMAC score showed significant reduction from baseline (61.6) to 3rd treatment procedure visit (32.1), 3 months (16.2) and 6 months follow up visit (4.8) respectively (p<0.001). Significant improvement was observed in quality of life from baseline values to 3 month and 6 month follow up visit (p<.0001) Discussion: Studies have shown that HA is safe and well tolerated to achieve clinically significant improvement in patients with mild to moderate knee OA. It is presented that repeated IAHA injections are an effective treatment for knee OA, and reduce pain and contribute to recovery. It was concluded that HA with higher molecular weight improved pain more and suggested that the use of HA products may be effective in knee OA. A significant increase was observed in SF-36 parameters reporting quality of life with IAHA, and HMW-IAHA added to usual care is effective for knee OA in working individuals. Conclusion: Three weekly IA injections of HA provided pain relief and functional improvements with high treatment satisfaction in patients with painful knee OA lasted for a minimum 6 months.
Therapeutic advances in musculoskeletal disease, 2015
Prolotherapy is an injection-based complementary treatment, which has shown promising results in the treatment of different musculoskeletal disorders. The aim of this study was to determine the therapeutic efficacy of dextrose prolotherapy on pain, range of motion, and function in patients with knee osteoarthritis (OA). In this single-arm prospective study, participants with symptomatic moderate knee osteoarthritis underwent prolotherapy with intra-articular injection of 20% dextrose water at baseline, and at 4 weeks and 8 weeks later. Patients were followed for 24 weeks. Pain severity at rest and activity, according to the visual analog scale (VAS), articular range of motion (ROM), and Western Ontario and McMaster Universities arthritis index (WOMAC) scores were measured at baseline, 4, 8, and 24 weeks later. A total of 24 female patients (average age: 58.37 ± 11.8 years old) received 3-monthly injection therapies. Before the treatment, the mean articular range of motion was 105.41...
Managing knee ostheoarthritis: efficacy of hyaluronic acid injections
Acta reumatologica portuguesa, 2013
Osteoarthritis (OA) is the most common form of chronic arthritis worldwide. The etiology of pain in osteoarthritis is multifactoral, and includes mechanical and inflammatory processes. The use of intra-articular viscosupplementation in the nonoperative management of patients with osteoarthritis has become quite popular. Recent clinical data have demonstrated that the anti-inflammatory and chondroprotective actions of hyaluronic acid viscosupplementation reduce pain, from 4 to 14 weeks after injection, while improving patient function. Viscosupplements are comparable in efficacy to systemic forms of active intervention, with more local reactions but fewer systemic adverse events, and hyaluronic acid has more prolonged effects than IA corticosteroids. Although several randomized controlled trials have established the efficacy of this treatment modality, additional high quality randomized control studies with appropriate comparison are still required to clearly define the role of intra...
The objective of this study was to compare the efficacy of low molecular weight intra-articular hyaluronic acid (LMW IA-HA,1.4X106 Dalton) and high molecular weight intraarticular hyaluronic acid (HMW IA-HA 6X106 Dalton) in the rigkt/left knee of each patient. A prospective, randomized, single blind clinical trial was conducted in patients with primary OA of both knees and radiographic changes to Kellgren & Lawrence stage II or III bilaterally. Each patient received both drugs, only one drug to one knee, by simple randomization and the study was conducted for 17 weeks. Thirty two patients were enrolled in the study; one group of 32 knees received LMW IA-HA and the other group of 32 knees received HMW IA-HA. At the end of the study, the total WOMAC scores decreased significantly in both LMW and HMW IA-HAs treated knees (p<0.001). However, there was no significant difference of the total WOMAC scores between both groups (p=0.689). Both of the patient and physician global assessments showed that HMW IA-HA treated knee group had a significant lower score (p<0.001). The most frequently detected adverse drug reaction (ADR) was transient pain at the injection site and no serious ADR was reported.
International Journal of Research in Medical Sciences, 2016
Background: Osteoarthritis (OA) is the most common disease of joints in adults around the world. Worldwide, it is estimated to be the fourth leading cause of disability. Objective of the study was to assess functional outcome and results of injection of hyaluronic acid in symptomatic osteoarthritis knee. Methods: It was a prospective clinical study with 3 months of follow-up. Clinically proven sixty patients of osteoarthritis knee (OA) included in study according to inclusion and exclusion criteria on OPD basis after getting written and informed consent, treated by weekly intra articular injection of Hyaluronic acid (20 mcg/2ml) in affected knee joint for 5 weeks by single author. Functional outcome and clinical assessment was done by pain at visual analogue score (VAS) and by knee range of movements, patients global assessment of treatment and physician global assessment of treatment. The occurrences of adverse events were also assessed at 3 month. Results: Sixty patients participated in study and reported statistically significant improvement in VAS score in mild and moderate osteoarthritis of knee from 4.46±0.52 and 6.57±0.72 points respectively pre-treatment level to 2.26±0.43 and 4.36±0.24 points respectively at three months post Hyaluronic acid injection follow up, improvement in joint tenderness and patients & physician's global assessment score also improved significantly clinically as well as statistically in mild to moderate group while in severe group no clinical and statistically significant improvement was observed in any parameters, change in range of motion at three months was not significant in any group. Conclusions: Visco-supplementation with intra articular injection hyaluronic acid should be considered as safe and effective modality of treatment in selected group of mild to moderate osteoarthritis before mechanical changes takes place and patient complies with regular exercise, weight control and postural habits.