Biological Response of Stage IV Knee Osteoarthritis to Serial 12.5% Dextrose

Historical, compliance, examination,anesthetic injection, radiographic and arthroscopic screening will be completed. One month after arthroscopy completion, the intervention phase will begin.

INTERVENTION

• Injection of 12.5% dextrose at 0, 1 and 2 months.
• Stand up without using only the non-injected leg for 3 days after each injection.
• Avoid running and squatting as feasible.
• Ensure that the injected knee descends stairs first ascends stairs last for 3 days.
• May take Acetaminophen.
• No NSAIDS for 2 days before and 10 days after a treatment. PRN NSAIDs only.
• No glucosamine or chondroitin should be taken.

SECOND ARTHROSCOPY TIMING

• A minimum of 4 months after first arthroscopy, when schedulable.
• After a minimum of 3 monthly injections of dextrose 12.5% .

METHOD OF ARTHROSCOPY

• Only the medial compartment will be entered to minimize trauma.
• Methylene blue will be applied and allowed to remain in knee for 5 minutes prior to flush.
• A standardized method video scan of the medial femoral compartment will be conducted.
• At second arthroscopy, the area of heaviest cartilage growth, if any, in the base of the Out-IV lesion will be biopsied with a Jamshidi needle at a 45 degree angle. (Limited by the optics of single port entry ).
• Biopsy, if taken, will be sent for decortication to enable specimen to be cut, safranin O application to determine proteoglycan production, polarized light to differentiate fibrous from hyaline cartilage, and immunohistologic straining for Type I and Type Ii cartilage.

Inclusion criteria

• Weight ≤ 90 kilos.
• Available for clinic any day.
• Agreeable to keep coming if pain stops.
• More than one phone number.(close relative ok)
• Willing to wait 6 months prior to considering a TKA.
• Good strength in arms to help stand.
• Knee flexion more than 100 degrees.
• 90% reduction of standing, walking and sitting pain 5 minutes after intraarticular injection of 9 ml of 0.25% dextrose.
• XRay repeat with camera at knee height confirms bone on bone status in the medial compartment.

Exclusion criteria

• No dementia.
• No radiating back pain.
• No systemic inflammatory conditions.
• No history of knee fracture or infection.
• No cancer history.
• No blood thinners.
• No daily narcotic.
• No walking limitation from another cause.
• Repetitive squatting or stair use on job.
• Inability to use one arm to help come to stand.
• Painful hip ROM or imitative of patient's pain.
• Knee extension lacking more than 15 degrees on each side.
• Any degree of valgus.
• Varus of 20 degree or more.
• A painful Baker's cyst.
• Visible bone shift when walking
• Meniscal tear seen on arthroscopy that could block motion and needs trimming.
• Significant loose bodies seen on arthroscopy.
• Severe synovitis seen on arthroscopy.
• More than 1 outerbridge lesion in the medial compartment of the femur.