A study on the effect of hypertonic dextrose injection in Osteoarthritis knee-A Cohort study

Knee Osteoarthritis is a chronic, progressive and disabling joint disease1. Knee OA is important due to high prevalence of pain and disability that they cause in older adults. It is estimated that over 80% of people over 55years of age have osteoarthritis of at least one joint. Pain origin is from both intra articular as well as extra articular structures2,3 resulting in decreased function of the joint. Conservative management by any single therapy has shown no clear benefit. Standard of care involves multiple disciplines.4

Currently available treatment modalities focus majorly on symptom relief and improvement of joint function rather than modifying the disease progression. There is ongoing research on various disease modifying treatments that regulate cartilage breakdown and formation, modulation of inflammation and subchondral bone remodeling. In recent years, a variety of treatment modalities have been researched upon but these interventions incur considerable costs and have questionable efficacy.5

Modern use of prolotherapy dates back to the 1950s, with increased focus by physicians in 1990s. Hypertonic dextrose therapy is an injection therapy used for chronic musculoskeletal injury, including knee osteoarthritis.6,7 The underlying principle is the injection of small volumes of an irritant solution at multiple tender ligament and tendon insertion sites and in adjacent intra articular joint spaces over several strategically spaced treatment sessions. The irritant solution leads to initiation of a local inflammatory cascade, leading to proliferation of tissue and remodeling of bone and cartilage. Even though exact mechanism of action is unknown but potential mechanisms have been put forth suggesting regeneration and repair of tissue by inciting inflammation by use of irritant solutions. Other proposed mechanisms are increase in PDGF (platelet derived growth factors) and direct acting on pain modulation

Osteoarthritis knee presents a great burden and disability in the elderly population without any standard treatment recommendations with only joint replacement as the definitive management in end stage disease and symptomatic treatment in early stages with no definitive cure. Joint replacement as a definitive treatment presents its own challenges in being expensive, surgical complications, patients with co-morbidities unfit for surgery. Prolotherapy is an emergent non-surgical, effective, affordable therapy suitable for the patients in different stage of disease and those unfit to undergo surgery.

The need for this study arises due to scanty research and underpowered studies in the use of hypertonic dextrose therapy in the treatment of osteoarthritis knee.