Hypertonic-Dextrose Intra-Articular Injections in Severe Knee Osteoarthritis: A Pilot Study Suggesting Disease Modification through Chondrogenesis

Objective(s): To assess biological and clinical effects of intra-articular hypertonic dextrose injections in painful severe knee osteoarthritis (KOA). Hypertonic dextrose injection is reported to improve KOA-related pain, stiffness and function, but its effect on articular cartilage is unknown. Design: Open label pilot study. Setting: Outpatient pain medicine and day surgery practice. Participants: Adults with knee pain for at least 6 months, arthroscopyconfirmed medial compartment Outerbridge IV KOA, and temporary pain relief with intra-articular lidocaine injection. Interventions: 6 monthly 10 mL intra-articular injections with 12.5% dextrose. Main Outcome Measure(s): Assessed at baseline and 7.5 2.0 (range 4.59.5) months: Video arthroscopy of 9 standardized medial condyle zones was performed before and after treatment; semi-quantitative visual cartilage growth assessment of each zone (+1.0,-1) was performed by 3 surgeon-reviewers. Biopsies of cartilage growth-area was obtained posttreatment and evaluated using HE Fleiss kappa Z0.901).Biopsy specimens showed metabolically active cartilage with variable cellular organization, fiber parallelism, and cartilage typing patterns consistent with fibroand hyaline-like cartilage. Compared with baseline status, participants reported improved WOMAC scores (17.6 4.7 points; pZ.013). Self-limited soreness after methylene-blue instillation was noted. Conclusions: Positive clinical and chondrogenic effects were seen after hypertonic dextrose injection in symptomatic grade IV KOA suggesting disease-modifying effects and the need for confirmation in controlled studies.