Abstract
Background Knee osteoarthritis is a common disease that is associated with chronic pain and disability in patients. Prolotherapy is a complementary therapeutic approach for improving pain and function in patients with osteoarthritis. We aimed to compare the effect of hypertonic saline with ozone plus hypertonic saline in improving the symptoms of osteoarthritis in the patients. Materials and Method. In this clinical trial, thirty-four adults with painful primary knee osteoarthritis for at least three months were randomized to two groups: ozone plus hypertonic saline 5% and hypertonic saline 5% alone. Prolotherapy and thrice follow-up with two-week intervals were done. The outcome measures included Oxford Knee Scale (OKS), Western Ontario McMaster University Osteoarthritis Index (WOMAC), and Visual Analog Scale (VAS), which were obtained from the patients before the injection and after the 2nd and 4th weeks after the start of the study. Results The mean age of the participants was 60.12 ± 7.54 years. There were no statistically significant differences between demographic characteristics before the injection between the two groups (p > 0.05). The results showed that VAS and OKS values decreased over time (p < 0.001) in each group, but there was no significant difference in the reduction of those between the two treatment groups (p = 0.734 and p = 0.734, respectively). Both interventions improved the mean values of WOMAC pain, WOMAC stiffness, WOMAC act, and WOMAC total. However, there was no significant difference in WOMAC pain reduction rate (p = 0.465), WOMAC stiffness rate (p = 0.656), WOMAC act rate (p = 0.376), and WOMAC total rate between the two methods (p = 0.528). Conclusion The results showed that intra-articular prolozone therapy and hypertonic saline injection can lead to improvement of pain and function in patients with knee osteoarthritis at the same status without any significant difference.
Highlights
Osteoarthritis, the most common form of arthritis, is the leading cause of musculoskeletal pain and disability worldwide [1]
Study Population. is is a double-blind randomized clinical trial. irty-four patients who referred to Imam Reza and Shahid Rajaee Clinics affiliated to Shiraz University of Medical Sciences in March 2016 to March 2017 were selected. e inclusion criteria were having 1st or 2nd grade of OA based on radiologic Kellgren-Lawrence criteria [27] and having symptoms of knee osteoarthritis for at least three months after receiving paracetamol, NSAIDs, opioids, or physical and therapeutic exercises, with no other neuromuscular diseases
Patients who had evidence of 3rd or 4th grade of OA based on radiologic Kellgren-Lawrence criteria; a history of knee surgery, trauma, any intra-articular injection in the past 3 months, or prolotherapy in the past year; lower extremities deformity, any kind of disease disturbing the symptoms of knee pain such as active lumbar radiculopathy and neuropathy; and diabetes or rheumatic diseases such as rheumatoid arthritis, lupus, Ritter’s disease, gout, and Brucella were excluded from our study
Summary
Osteoarthritis, the most common form of arthritis, is the leading cause of musculoskeletal pain and disability worldwide [1]. Knee osteoarthritis is a common disease that is associated with chronic pain and disability in patients. Prolotherapy is a complementary therapeutic approach for improving pain and function in patients with osteoarthritis. We aimed to compare the effect of hypertonic saline with ozone plus hypertonic saline in improving the symptoms of osteoarthritis in the patients. In this clinical trial, thirty-four adults with painful primary knee osteoarthritis for at least three months were randomized to two groups: ozone plus hypertonic saline 5% and hypertonic saline 5% alone. E outcome measures included Oxford Knee Scale (OKS), Western Ontario McMaster University Osteoarthritis Index (WOMAC), and Visual Analog Scale (VAS), which were obtained from the patients before the injection and after the 2nd and 4th weeks after the start of the study. Results. e mean age of the participants was 60.12 ± 7.54 years
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