Periarticular dextrose prolotherapy after total knee arthroplasty: a retrospective case series

Abstract

Background: Total knee arthroplasty (TKA) is generally considered an effective procedure for patients with end-stage osteoarthritis or inflammatory conditions of the knee. However, a significant number of patients experience continued pain post-operatively. There are limited effective treatment options available to address this, some of which are invasive and contain considerable risk and/or practitioner expertise. We present a novel, easy to learn and minimally invasive treatment for idiopathic post-TKA pain using periarticular prolotherapy injections. Case Description: A series of three patients underwent periarticular prolotherapy injections with improvement in pain using the Numeric Pain Rating Scale (NPRS) and function using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). In all three patients, a solution consisting of 2 cc 50% dextrose, 2 cc normal saline and 2 cc 1% lidocaine was injected into four specific subcutaneous locations surrounding the knee joint. With reexamination of the patients on follow-up clinic visit, it was found that each patient experienced greater than 50% improvement of their subjective pain symptoms, as well as improvement in function. Conclusions: This case series demonstrates a novel dextrose prolotherapy injection technique that is easy for clinicians to learn and perform. This is an accessible and relatively safe treatment option for chronic idiopathic post-TKA pain.