Assessment effectiveness of hypertonic dextrose prolotherapy compared with erythropoietin, platelet-rich plasma and radiofrequency prolotherapy in knee osteoarthritis treatment in Iran

Aims and background: Knee osteoarthritis (OA) is a major public health issue because it causes chronic pain, reduces physical function and diminishes quality of life. Knee osteoarthritis is a chronic disease and is one of the most common causes of disability in the elderly. Population ageing and increased global prevalence of obesity are anticipated to dramatically increase the prevalence of knee OA and its associated impairments. Because of direct and indirect costs, it is costly for patients and community. No definitive treatment for knee osteoarthritis is known, but prolotherapy is a complementary injecting drug for chronic muscular pain, including knee osteoarthritis, which is used to stimulate repair of soft tissue and decrease the pain associated with chronic soft tissue damage. Therefore, the present study was conducted to evaluate various prolotherapy methods for the treatment of patients with knee osteoarthritis. Materials and methods: A systematic literature search was conducted in five medical electronic databases, PubMed, Scopus, Medline, Cochrane Collaboration and Google Scholar, up until April 2018. We included randomized controlled trials and quasi-randomized controlled trials (where the allocation is not strictly random (comparing dextrose with erythropoietin, platelet-rich plasma and radiofrequency for osteoarthritis of the knee in adults. Risk of bias analysis and best evidence synthesis were performed. The main aspects related to treatment were analyzed: decrease in pain level, stiffness, physical function and range of motion. Findings: Two clinical trials including 112 patients were included in this study. The results analysis showed that, the level of pain reduction in the erythropoietin group was 52.5% higher than the rest of the treatment methods in first month after treatment. In comparison to dextrose group and in the 6th month after treatment, the rate of knee stiffness, functional limitations, and overall WOMAC score in patients treated with PRP were decreased 53.7%, 52.3% and 53.7%, respectively. In the third month after treatment, the knee range in patients treated with erythropoietin showed a 25.4% improvement, which was more effective than other procedures. Conclusions: According to study result, the effectiveness of intra-articular injection methods for knee osteoarthritis treatment and in order to reduce the pain level, respectively, were: erythropoietin, radiofrequency pulse, platelet-rich plasma, and dextrose. It should be noted that more research is needed to estimate the effectiveness of these methods in the long run.