Hypertonic dextrose compare with other substances for knee osteoarthritis: a meta-analysis of randomized control trial

Background: Globally, osteoarthritis (OA) highly prevalent in the elderly more than 80% of those over 55 years old. At least 151 million people worldwide are afflicted. The knees, hips and spine are the joint areas that are most frequently affected. For the treatment of knee OA, intra-articular injection like stem cells, platelet rich plasma (PRP), and hypertonic dextrose (HD) the most used prolotherapy fluid is HD. It is widely accessible, reasonably inexpensive priced and reportedly safe. The aim of this meta-analysis is to thoroughly assess and compare the results of intra articular dextrose prolotherapy with hyaluronic acid and normal saline, with a focus on visual analog scale (VAS) and WOMAC score. Methods: A comprehensive search was conducted across major electronic databases for relevant studies published from 2014 to 2024. Studies that compare intra articular dextrose prolotherapy with hyaluronic acid and normal saline for knee OA were included. We recorded the first author, year, study design, sample number, age, sex, Kellgren Lawrence grade, VAS and WOMAC score were extracted and analyzed using appropriate statistical methods. Results: The initial search yielded a total of 2371 studies, of which 7 studies met the inclusion criteria, consisting of a total of 372 patients of intra articular dextrose prolotherapy with hyaluronic acid and normal saline for knee OA. It shows that there is no significant difference in VAS score between two groups (MD=-0.72, 95% CI:-1.74 to 0.31, p=0.17). There was no difference in WOMAC score between two groups. Conclusions: Our results show that both methods provide similar outcome in pain scale and WOMAC score. More over to enhance the efficacy of prolotherapy in comparison to alternative treatments like HA or saline injections, it is suggested that a multicenter clinical trial with a larger number of participants be carried out.