Journal of Pain Research (Jul 2022)
Combine Approach of Proximal Fibula Osteotomy (PFO) Followed by Intra-Articular Dextrose Prolotherapy in Severe Medial Knee Osteoarthritis
Abstract
Alif Noeriyanto Rahman,1,2 Herry Herman,2,3 Eri Kriswanto,2,4 Ahmad Faried,2,5 Mochammad Kamal Nasser6 1Musculoskeletal Pain Intervention and Regeneration, Faculty of Medicine Universitas Padjadjaran, Orthopaedic and Pain Intervention Center of Sentra Medika Hospital, Depok, Indonesia; 2Pain Intervention and Regeneration, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia; 3Department of Orthopaedic and Traumatology Hasan Sadikin General Hospital Faculty of Medicine Padjadjaran University, Bandung, West Java, Indonesia; 4Department of Orthopaedic and Traumatology Baptist Hospital, Kediri, Indonesia; 5Department of Neurosurgery, Hasan Sadikin General Hospital Faculty of Medicine Padjadjaran University, Bandung, West Java, Indonesia; 6Baptist Hospital, Kediri, IndonesiaCorrespondence: Alif Noeriyanto Rahman, Musculoskeletal Pain Interventional and Regeneration, Faculty of Medicine Universitas Padjadjaran, Orthopaedic and Pain Intervention Center of Sentra Medika Hospital, RS Sentra Medika Cisalak Depok (Jl Raya Jakarta Bogor, Cisalak, Kota Depok, Jawa Barat), Depok, Indonesia, Tel +6281233889873, Email [email protected]: Knee osteoarthritis (OA) is a chronic and progressive degenerative disease. It resulted from mechanical and chemical disorders that damage the joint and the underlying bone. The management of knee OA is challenging due to poor self-regeneration of connective tissues. Surgical treatment with prolotherapy approaches was conducted to treat medial compartment knee OA.Aim: To know the injection frequency to reach a 50% improvement in VAS score and WOMAC index.Methods: Six patients who suffered from late-stage medial compartment knee OA underwent PFO followed by twelve sessions of intra-articular dextrose prolotherapy. The subjective pain score, visual analog scale (VAS), was assessed based on the patient subjectiveness before and after treatment. Patients marked the score from 0 to 10 cm to describe the current pain state. The functional index, the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index used to evaluate the Patient’s clinical symptoms. It ranges from 0 to 96 points consisting of three main sections: pain (total 20 points), stiffness (total: eight points), and physical function disability (total 68 points). Higher scores indicate severe symptoms and function.Results: Four patients showed pain relief and functional improvement with more than 50% scores of VAS and WOMAC after the treatment. Two patients received more than twelve doses of intra-articular dextrose prolotherapy due to a lack of progress.Conclusion: This study provides clinical evidence for a new treatment strategy for advanced knee OA. This combined therapy improves the patient’s daily activity function and postpones the need for total knee arthroplasty (TKA).Keywords: knee osteoarthritis, proximal fibula osteotomy, dextrose prolotherapy
