Highlights
- •Hyaluronic acid and dextrose injections are common treatments for knee osteoarthritis (OA).
- •Coinjections improved stair climbing time and physical function at 6 months.
- •Coinjections had no severe adverse effects and achieved high adherence.
- •Coinjections may be suitable as adjuvant therapy for knee OA.
Abstract
Objective
To determine whether intra-articular coinjection with hypertonic dextrose improves
the outcome of hyaluronic acid (HA) prolotherapy for knee osteoarthritis (OA).
Design
Prospective, randomized, double-blind trial.
Setting
Medical center in Taiwan.
Participants
In total, 104 participants who fulfilled the American College of Rheumatology clinical
and radiographic criteria for knee OA with a Kellgren-Lawrence score of 2 or 3 were
recruited (N=104).
Interventions
The participants were blocked randomized to the treatment (HA and hypertonic dextrose)
or control (HA and normal saline) group. Ultrasound-guided knee intra-articular injections
were administered once a week for 3 weeks.
Main Outcome Measures
The primary outcomes were performance-based physical function measures (regular and
fastest walking speed, stair climbing time, and chair rising time), and the secondary
outcomes were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)
and Knee Injury and Osteoarthritis Outcome Score (KOOS). The outcome measures were
assessed before the injections and at 1 week and 1, 3, and 6 months after the injections.
The data were analyzed through repeated-measures analysis of covariance.
Results
Significant intergroup difference-in-differences favoring the treatment group were
observed for improvements in stair climbing time (−1.6; 95% confidence interval, −8.56
to 4.16; P=.38) and WOMAC physical function (−21.2; 95% confidence interval, −126.05 to 103.83;
P = .045) at 6 months. The group×time interaction effects favored the treatment group
for regular (P=.001) and fastest walking speed (P=.001) and chair rising time (P=.038); WOMAC stiffness (P < .001) and physical function (P = .003); and KOOS for pain (P = .035), other symptoms (P=.022), and quality of life (P=.012).
Conclusions
Compared with HA plus normal saline coinjections, HA plus dextrose coinjections resulted
in more significant improvements in stair climbing time and physical function at 6
months, effectively decreased pain, and improved physical function and physical functional
performance from 1 week to 6 months. HA plus dextrose coinjections could be a suitable
adjuvant therapy for patients with knee OA.
Keywords
List of abbreviations:
HA (hyaluronic acid), IL (interleukin), KOOS (Knee Injury and Osteoarthritis Outcome Score), MCID (minimal clinically important difference), OA (osteoarthritis), QOL (quality of life), WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 16, 2022
Accepted:
April 12,
2022
Received in revised form:
April 12,
2022
Received:
August 3,
2021
Footnotes
Partially supported by research grants from Shin Kong Wu Ho-Su Memorial Hospital (2019SKHADR038, 2020SKHADR035, 2021SKHADR032, 2022SKHADR033) and the Ministry of Science and Technology, Taiwan (MOST-102-2314-B-341-001, MOST 104-2314-B-002-118-MY3, MOST-105-2314-B-341-002, MOST-105-2314-B-002-049-MY3, MOST-106-2314-B-341-003-MY2, MOST 108-2314-B-341-003, MOST 108-2314-B-002-127-MY3, MOST 109-2314-B-341-001).
Clinical Trial Registration No.: NCT03238183.
Disclosures: none.
Identification
Copyright
© 2022 by the American Congress of Rehabilitation Medicine.
