Gül et al published a randomized trial of osteoarthritis of the hip specifically in those with developmental dysplasia of the hip, comparing dextrose prolotherapy to a supervised progressive exercise program. Here is that citation --> Gül D, Orsçelik A, Akpancar S. Treatment of Osteoarthritis Secondary to Developmental Dysplasia of the Hip with Prolotherapy Injection versus a Supervised Progressive Exercise Control. Med Sci Monit. 2020 Feb 11;26:e919166. doi: 10.12659/MSM.919166. PMID: 32045406; PMCID: PMC7034518.
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Design: This was a randomized study with supine position injection of up to 8 ml of 13.5% dextrose into iliopsoas and adductor tendon insertions, and 8 ml intraarticular, (except in Crowe III and IV), and lateral decubitus injection of the gluteus medius, minimus and piriformis insertions every 21 days until pain reduction by 75% or a maximum of 6 sessions versus 12 weeks of supervised progressive resistive exercises according to American College of Sports Medicine guidelines followed by home exercise plan.
Participants: Those with 6 months of symptomatic osteoarthritis secondary to developmental dysplasia of the hip (Crowe Type I-IV on AP radiographs) refractory to 3 months of standard care (Weight loss, partial weight-bearing heel risers, and physical therapy) and on a waiting list for total hip arthroplasty.
Study size: 46 hips in 44 participants (20 DPT and 21 exercise control) Dropout from study data collection was not mentioned.
Bias: Computer-derived randomization charts for assignment to groups. Blinding of allocation until after initial data collection was not mentioned.
Measures: VAS (0-10) for pain and Harris Hip Score (HHS) to 12 months. Standard scoring measures.
ITT versus Per Protocol Analysis: Analysis as by intention to treat.
Other treatments offered: Home exercise program for DPT patients starting 3 days post injection.
Results: Both groups improved substantially to 1 year follow up. From day 21 on dextrose injection outperformed exercise, and at 12 months dextrose injection recipients outperformed exercise controls for VAS pain change score (–4.5±2.4 versus –2.9±2.5; P=0.017)and HHS change score (24.3±13.4 versus 16.5±11.3; P=0.018). The dextrose group averaged close to the maximum number of allowed sessions (5.26±0.92)
Limitations: Lack of placebo control. This would be a B- level of that evidence for that reason but this is not an easy group to treat and DPT group performed substantially better
Bottom Line 2020 Gül: DPT > Exercise control @ 1 year In DDH-related OA
Design: This was a randomized study with supine position injection of up to 8 ml of 13.5% dextrose into iliopsoas and adductor tendon insertions, and 8 ml intraarticular, (except in Crowe III and IV), and lateral decubitus injection of the gluteus medius, minimus and piriformis insertions every 21 days until pain reduction by 75% or a maximum of 6 sessions versus 12 weeks of supervised progressive resistive exercises according to American College of Sports Medicine guidelines followed by home exercise plan.
Participants: Those with 6 months of symptomatic osteoarthritis secondary to developmental dysplasia of the hip (Crowe Type I-IV on AP radiographs) refractory to 3 months of standard care (Weight loss, partial weight-bearing heel risers, and physical therapy) and on a waiting list for total hip arthroplasty.
Study size: 46 hips in 44 participants (20 DPT and 21 exercise control) Dropout from study data collection was not mentioned.
Bias: Computer-derived randomization charts for assignment to groups. Blinding of allocation until after initial data collection was not mentioned.
Measures: VAS (0-10) for pain and Harris Hip Score (HHS) to 12 months. Standard scoring measures.
ITT versus Per Protocol Analysis: Analysis as by intention to treat.
Other treatments offered: Home exercise program for DPT patients starting 3 days post injection.
Results: Both groups improved substantially to 1 year follow up. From day 21 on dextrose injection outperformed exercise, and at 12 months dextrose injection recipients outperformed exercise controls for VAS pain change score (–4.5±2.4 versus –2.9±2.5; P=0.017)and HHS change score (24.3±13.4 versus 16.5±11.3; P=0.018). The dextrose group averaged close to the maximum number of allowed sessions (5.26±0.92)
Limitations: Lack of placebo control. This would be a B- level of that evidence for that reason but this is not an easy group to treat and DPT group performed substantially better
Bottom Line 2020 Gül: DPT > Exercise control @ 1 year In DDH-related OA