Early Effects of Hypertonic Dextrose versus Corticosteroid on Pain and Activity, in Knee Osteoarthritis; A Randomized Clinical Trial

Background: Knee osteoarthritis is highly prevalent and causes debilitating pain, progressive movement limitation, and significant socio-economic costs. Intra-articular corticosteroids are widely used to control it, but only short-term effects have been proven for them. Also, they have shown many local and systemic side effects, including cartilage destruction and infection susceptibility. Knee prolotherapy in various forms of hypertonic dextrose injection has shown significant restorative effects, long-lasting pain and activity improvement, negligible side effects, and low cost. The objective is to compare the early effectiveness of intra-articular dextrose with corticosteroids regarding pain and activity changes in knee osteoarthritis. Materials and Methods: In this short-term blinded randomized clinical trial, 70 participants (knees) with primary osteoarthritis grade II or more were divided (1=1) into two random groups that received a single injection of triamcinolone 40 mg or hypertonic dextrose 20% five cc. Visual analog score (VAS) for pain and the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score for activity were assessed before, one week after, and one month after injection. The data was analyzed using independent t-test, chi-square, Fisher's exact tests, Repeated measure test, and the linear mixed model regression. Results: The rest and activity VAS score and WOMAC score were reduced in both groups one week and one month after injection, and the difference between the two groups was non-significant for the VAS score but significant for the WOMAC score in favor of the dextrose group. Conclusion: The early analgesic and activity-improvement effects after hypertonic dextrose injection in the arthritic knee are significant and comparable to corticosteroids.