Prolotherapy in the Treatment of Knee Osteoarthritis

Abstract

To compare the clinical outcomes of intra-articular hyaluronic acid injections and hypertonic dextrose prolotherapy (HDP) in the conservative treatment of mild to moderate knee osteoarthritis. Ninety patients aged between 40 and 75 years were selected, all with a diagnosis of bilateral idiopathic knee osteoarthritis, classified radiographically according to the Kellgren–Lawrence classification as grade III or lower in both knees, and presenting a full range of motion (0–120°). Patients were randomized by simple randomization into three distinct groups: Group A consisted of 30 patients who received 25% HDP; Group B consisted of 30 patients who received 15% HDP; and Group C consisted of 30 patients who received intra-articular hyaluronic acid (IAHA). Patients were subsequently followed in the outpatient clinic, with pain and function assessed using the Visual Analog Scale (VAS) and questionnaires such as the Knee Society Score (KSS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 1, 3 and 6 months. Results at the 6-month follow-up demonstrated that all three treatment protocols resulted in significant improvements in pain and function (p < 0.05); however, no statistically significant differences were observed among the groups (p > 0.52). The favorable effects on pain relief and functional improvement were uniformly distributed among the treatment groups, with no measurable advantage of one protocol over another.