Journal of
Prolotherapy. 2009;2:76-88.
A Retrospective Study on
Hackett-Hemwall Dextrose Prolotherapy for Chronic Hip Pain at an
Outpatient Charity Clinic in Rural Illinois
Ross A. Hauser, MD &
Marion A. Hauser, MS, RD
abstract
Objective:
To investigate the outcomes of patients undergoing Hackett-Hemwall
Dextrose Prolotherapy
treatment for chronic
hip pain.
Design: Sixty-one patients, representing 94 hips who
had been in pain an average of 63 months, were treated quarterly with
Hackett-Hemwall dextrose
Prolotherapy. This included a subset of 20
patients who were told by their medical doctor(s) that there were no
other treatment options for their pain and a subset of eight patients
who were told by their doctor(s) that surgery was their only option.
Patients were contacted an average of 19 months following their last
Prolotherapy session and asked questions regarding their levels of pain,
physical and psychological symptoms and activities of daily living,
before and after their last
Prolotherapy treatment.
Results: In these 94 hips, pain levels decreased from
7.0 to 2.4 after
Prolotherapy; 89% experienced more than 50% of pain
relief with Prolotherapy; more than 84% showed improvements in walking
and exercise ability, anxiety, depression and overall disability; 54%
were able to completely stop taking
pain medications. The decrease in
pain reached statistical significance at the p<.0001 for the 94 hips,
including the subset of patients who were told there was no other
treatment options for their pain and those who were told surgery was
their only treatment option.
Conclusion: In this retrospective study on the use of
Hackett-Hemwall dextrose Prolotherapy, patients who presented with over
five years of unresolved hip pain were shown to improve their pain,
stiffness, range of motion, and quality of life measures even 19 months
subsequent to their last Prolotherapy session. This pilot study shows
that Prolotherapy is a treatment that should be considered and further
studied for people suffering with unresolved hip pain.
introduction
Chronic hip pain is a common condition resulting in over 383,000
hip replacements annually in the United States and the number is increasing
every year.1 The high rates
of wear and tear, attributable to normal use of the hip, can result in
long term problems. This makes sense when one considers that patients
move their hips at least one million times per year during activities of
daily living.2,3
Population-based surveys of patients who have
arthritis of the hip
document a large untapped need for these procedures, suggesting that the
rates of total hip arthroplasty will likely increase in the future.4
Not everyone who is a candidate for a new hip will choose this option,
as the operation has inherent risks including poor outcome, osteolysis
and need for revision, deep vein thrombosis and limited life span.5,6
Because of the limited response of chronic hip pain to other traditional
therapies, many people are turning to alternative therapies, including
Prolotherapy, for pain control.7,8
Prolotherapy is becoming a widespread form of pain management in both
complementary and allopathic medicine.9
Its primary use is in the pain management associated with tendinopathies
and ligament sprains in peripheral joints.10-12
It is also being used in the treatment of spine and joint degenerative
arthritis.13-14
Prolotherapy has long been used for
chronic low back pain arising from
the
sacroiliac joints and as an alternative to surgery.15-19
Prolotherapy has been shown in low back studies to improve pain levels
and range of motion.20-21
In doubleblinded human studies the evidence on the effectiveness of
Prolotherapy has been considered promising but mixed.22-25
George S. Hackett, MD,
coined the term Prolotherapy.26
As he described it, “The treatment consists of the injection of a
solution within the relaxed ligament and
tendon which will stimulate the
production of new fibrous tissue and bone cells that will strengthen the
‘weld’ of fibrous tissue and bone to stabilize the articulation and
permanently eliminate the disability.”27
Animal studies have shown that Prolotherapy induces the production of
new collagen by stimulating the normal inflammatory reaction.28,29
In addition, animal studies have shown improvements in ligament and
tendon diameter and strength.30-31
While Prolotherapy has been used for chronic hip pain, no study has been
published to date to show its effectiveness for this condition.32
To evaluate the effectiveness of Hackett-Hemwall dextrose Prolotherapy,
not just on hip pain but on quality of life measures, as well as its
ability to reduce or eliminate the need or other medical therapies
including total hip replacement this observational study was undertaken.
Patients and Methods
Framework and Setting
In October 1994, the primary authors started a Christian charity medical
clinic called Beulah Land Natural Medicine Clinic in an impoverished
area in southern Illinois. The primary treatment modality offered was
Hackett-Hemwall dextrose Prolotherapy for pain control. Dextrose was
selected as the main ingredient in the Prolotherapy solution because it
is the most common proliferant used in Prolotherapy, is readily
available, is inexpensive compared to other proliferants, and has a high
safety profile. The clinic met every three months until July 2005. All
treatments were given free of charge.
Patient Criteria
General inclusion criterion were an age of at least 18 years, having an
unresolved hip pain condition greater than six months that typically
responds to Prolotherapy, and a willingness to undergo at least four
Prolotherapy sessions, unless the pain remitted with less number of
Prolotherapy sessions.
Interventions
The Hackett-Hemwall technique of dextrose Prolotherapy
was used. Each patient received 40 to 60 injections of a 15% dextrose,
0.2% lidocaine solution with a total of 50 to 60cc of solution used per
hip. Each patient was given an intraarticular injection of 5 to 10cc of
solution via the lateral or posterior approach. Injections were given at
the bony attachments of the following structures around the hips
including: the greater trochanter, intertrochanteric crest, neck of
femur and dorsal ilium; ischiofemoral and ilofemoral ligaments; tensor
fasica lata; and gluteus medius, pyriformis, gemellus superior,
quadrates femoris, obturator internus, gemellus inferior and vastus
lateral muscles. These typical tender spots each injected with 0.5 to
1cc of solution, can be seen in Figure 1. No other therapies
were used. As much as the pain would allow, the patients were asked to
reduce or stop other pain medications and therapies they were using.
Figure 1. Typical injection sites for Hackett-Hemwall dextrose
Prolotherapy of the hip.
Statistical Analysis
For the analysis, patient percentages of the various responses were
calculated using Microsoft Excel by an independent computer consultant (D.G.),
who also had no previous knowledge of Prolotherapy. These responses,
gathered from patients before Prolotherapy, were then compared with the
responses to the same questions after Prolotherapy. The patient
percentages were also calculated for patients who answered yes to either
of the following two questions: Before starting Prolotherapy it was
the consensus of my medical doctor(s) that there were no other treatment
options that he or she knew of to get rid of my chronic pain? and
Before starting Prolotherapy my only other treatment option was
surgery. A matched sample paired t-test was used to determine if
there were statistically significant improvements in the before and
after Prolotherapy measurements for pain, stiffness, and range of motion
in the above three groups (total hips and two subgroups above).
Patient characteristics
Complete data was obtained on 61 patients representing 94 hips. Of the
61 patients, 72% (44) were female and 28% (17) were male. The average
age of the patients was 62 years-old. Patients reported an average of
five years, three months of pain. Fifty-four percent had pain longer
than four years and 39% had pain longer than six years. The average
patient saw three doctors before receiving Prolotherapy. Twelve percent
saw six or more doctors and another 22% saw four or five doctors for
their chronic hip pain. The average patient was taking 1.1 pain
medications. Thirteen percent stated that the consensus of their
doctor(s) was that surgery was the only answer to their pain problem,
and 33% of patients were told by their doctor(s) that there were no
other treatment options for their chronic pain. (See Table 1.)
| Table
1. Patient Characteristics at Baseline. |
| Total number of
patients treated |
61
|
| Total number of
hips treated |
94
|
| Average age of
patients |
62
|
| Percent of male
patients |
28%
|
| Percent of
female patients |
72%
|
| Number of prior
physicians seen |
3.1
|
| Average years
of pain |
5.3
|
| Informed
surgery only treatment option |
13%
|
| Informed no
other treatment option for their chronic hip pain |
33%
|
| Average number
of pharmaceutical drugs taken for pain |
1.1
|
Treatment Outcomes
Patients received an average of 4.7 Prolotherapy treatments per hip. The
average time of follow-up after their last Prolotherapy session was 19
months.
Pain, Crunching Sensation, Stiffness.
Patients were asked to rate their pain, crunching sensation and
stiffness on a scale of 1 to 10 with 1 being no pain/crunching/stiffness
and 10 being severe crippling pain/crunching/stiffness. The 61,
representing 94 hips had an average starting pain level of 7.0,
crunching sensation of 2.0 and stiffness of 4.4. Their average ending
pain, crunching and stiffness levels were 2.4, 1.2, and 2.0
respectively. Fiftyfour percent had a starting pain level of eight or
greater, while only 5% had a starting pain level of three or less,
whereas after Prolotherapy only 2% had a pain level of eight or greater
while 77% had a pain level of three or less. (See Figure 2.)
Figure 2. Starting and ending pain, stiffness, and cruching
levels before and after receiving
Hackett-Hemwall dextrose Prolotherapy
in 61 patients (94 hips) with unresolved hip pain.
Data
Collection
Patients who received Prolotherapy for their chronic hip pain in
the years 2001 to 2005 were called by telephone and interviewed by an
independent data collector (D.P.) who had no prior knowledge of
Prolotherapy. D.P. was the sole person obtaining the patient information
during the telephone interviews. The patients were asked a series of
detailed questions about their pain and previous treatments before
starting Prolotherapy. Their response to Prolotherapy treatments was
also documented in detail with an emphasis on the effect the treatments
had on their need for subsequent pain treatments and their quality of
life. Specifically, patients were asked questions concerning years of
pain, pain intensity, overall disability, number of physicians seen,
medications taken, stiffness, walking and exercise ability, activities
of daily living, quality of life concerns, psychological factors and
whether the response to Prolotherapy continued after their last
Prolotherapy session.
Range of Motion.
Patients were asked to rate their range of motion on a scale of 1 to 7
with 1 being no motion, 2 through 5 were fractions of normal motion, 6
was normal motion, and 7 was excessive motion. The average starting
range of motion was 4.3 and ending range of motion was 5.1. Before
Prolotherapy 30% had very limited motion (49% or less of normal motion),
this decreased to only five percent after Prolotherapy. Prior to
Prolotherapy only 36% had 75% or greater of normal range of motion but
this improved to 75% after Prolotherapy. (See Figure 3.)
Pain Medication Utilization.
Sixty percent discontinued pain medications altogether after
Prolotherapy. In all, 75% of patients on medications at the start of
Prolotherapy were able to decrease them by 75% or more after
Prolotherapy. None of the patients had to increase pain medication usage
after stopping Prolotherapy. Before Prolotherapy the average patient was
taking 1.1 pain medications but this decreased to 0.3 medications after
Prolotherapy. Before Prolotherapy 23% of patients were on two or more
pain medications, but this decreased to 2% after Prolotherapy.
Sixty-nine percent of clients using additional pain management therapies
before Prolotherapy were able to decrease them by 75% or more after
treatment.
Walking Ability.
Before Prolotherapy, 59% of patients experienced compromised walking
ability, but this decreased to 39% after Prolotherapy. Specifically, 38%
could walk three blocks or less before Prolotherapy, but this decreased
to 10% after Prolotherapy. While 27% of patients could walk less than
one block before Prolotherapy, all could walk greater than that distance
after Prolotherapy. (See Figure 4.)
Exercise and Athletic Ability.
In regard to exercise or athletic ability prior to Prolotherapy, 30%
reported totally compromised ability (couldn’t do any athletics), seven
percent ranked it as severely compromised (less than 10 minutes), 23%
ranked it as very compromised (less than 30 minutes) and a total of 84%
ranked it as at least somewhat compromised. After treatments, 80% of
patients were able to do 30 or more minutes of exercise with 40% not
being compromised at all. (See Figure 5.)
Disability. In regard
to quality of life issues prior to receiving treatment, 40% had an
overall disability of at least 50% (could only do about half of the
tasks they wanted to). This decreased to 11% after Prolotherapy.
Sixty-seven percent noted they had at least a 25% overall disability
prior to treatments and this decreased to 24% after.
Before receiving Prolotherapy, five of the patients were dependent on
someone for activities of daily living (dressing self and additional
general self care). All five regained complete independence after
Prolotherapy. Before Prolotherapy 11% considered themselves completely
disabled in regards to their work situation, but this decreased to seven
percent after Prolotherapy.
Depression and Anxiety.
Prior to Prolotherapy, 46% of patients had feelings of depression and
52% had feelings of anxiety. After treatments, only 13% had depressed
feelings and 21% had feelings of anxiety.
Sleep. Seventy-two percent of patients reported their
pain interrupted their
sleep prior to Prolotherapy treatments and 71%
subsequently experienced improvements in their sleeping ability.
Quality of Life. To a simple yes or no question:
Has Prolotherapy changed your life for the better? 98% of patients
treated answered “yes.” In quantifying the response:
| • |
Seventy-five percent felt
their life was at least very much better from Prolotherapy. |
| • |
Sixty percent stated that the
results from Prolotherapy have very much continued (>75%) to
this day. |
| • |
Ninety-eight percent felt that
they still have some benefits from the Prolotherapy they
received. |
When patients experiencing some regression were asked, “Are there
reasons besides the Prolotherapy effect wearing off that are causing
some return of my pain/disability?” 81% answered “yes.” The
patients noted the reasons for some of their returning pain were:
| • |
stopped Prolotherapy
treatments too soon (before pain completely gone) – 50% |
| • |
re-injury – 12% |
| • |
new area of pain – 14% |
| • |
had increased life stressors –
10% |
| • |
had other explanations for the
pain – 14% |
Of the patients whose pain recurred after Prolotherapy was stopped, 80%
were planning on receiving additional Prolotherapy treatments.
Patient Satisfaction. Eighty-five percent of patients
knew someone who had received and benefited from Prolotherapy. In fact,
seventy-five percent came to receive their first Prolotherapy session
because of the recommendation of a friend. Eighty-nine percent of
patients treated considered the Prolotherapy treatment to be very
successful (greater than 50% pain relief). (See Figure 6.)
Ninety-seven percent noted the Prolotherapy was at least somewhat
successful (greater than 25% pain relief). All 100% noted some benefit
in their pain with treatment. None indicated that the Prolotherapy
treatments made them worse. Ninety-five percent have recommended
Prolotherapy to someone.
Subgroup Analysis
Patient percentages were also calculated for patients who answered “yes”
to either of the following two statements:
1. “Before starting Prolotherapy it was the consensus of my medical
doctor(s) that there were no other treatment options that he/she knew to
get rid of my chronic pain.” and
2. “Before starting Prolotherapy my only other treatment option was
surgery.”
“No Other Treatment Options”
Subgroup. Twenty patients had been told by their doctors that
there were no other treatment options for their pain prior to presenting
for Prolotherapy. As a group they suffered with pain on average 69
months, saw 3.2 physicians and were on 1.5 medications for pain. Sixty
percent of these patients had pain longer than six years. In analyzing
these patients, they had a starting average pain level of 8.1 and after
Prolotherapy 3.1. Prior to Prolotherapy, 65% of the patients rated their
pain as a level eight or higher and none rated it a three or less. After
Prolotherapy none rated it an eight or higher and 70% rated it a three
or less. (See Figure 7.)
Starting levels of stiffness and
crunching levels were 5.9 and 3.1 and ending levels of 2.7 and 1.4,
respectively. In regard to range of motion, prior to Prolotherapy only
33% had 75% or greater normal range of motion, but this increased to 75%
after Prolotherapy. As a group, prior to Prolotherapy, 60% noted in
regards to activities of daily living, they could not do at least 50% of
the tasks they wanted to do. This decreased to 15% after Prolotherapy.
Twenty percent of patients before Prolotherapy could walk one block or
less, but all could walk over a block after Prolotherapy. Only 35%
percent said they were not compromised in regard to walking before
Prolotherapy, but this increased to 60% after Prolotherapy. Before
Prolotherapy 30% could not exercise at all, whereas after Prolotherapy
this was down to three percent. Only five percent ranked their exercise
ability as not compromised before Prolotherapy, but after Prolotherapy
67% rated it as not compromised. (See Figure 8.) For those
patients on pain medication, 80% were able to decrease them by 50% or
more after treatments. Twenty-five percent of patients on pain
medications were able to stop taking them after Prolotherapy.
Eighty-five percent were able to decrease their need for additional pain
therapies by 50% or more.
Eighty percent of these patients noted
the Prolotherapy treatment gave them greater than 50% pain relief with
50% of them receiving 75% or greater pain relief. In response to the
question Has Prolotherapy changed your life for the better? 100%
answered “yes.” All 100% have recommended Prolotherapy to someone else.
(See Table 2.)
“Surgery is the Only Treatment
Option” Subgroup. This group represents 13% of the patients
(eight in number). As a group they saw on average 4.2 physicians and
were taking 1.8 pain medications prior to Prolotherapy. They had pain
for an average of 44 months. Initial average pain level was 8.4, which
decreased to 2.4 after Prolotherapy. Eighty-eight percent had a pain
level of eight or more before Prolotherapy. None had a pain level under
a seven before Prolotherapy. After Prolotherapy, all had a pain level of
five or less with 63% of them having no pain. (See Figure 9.)
On average, 19 months after their last
Prolotherapy treatment, as a group they stated that 100% of their
improvement in daily pain had continued. Before Prolotherapy their
starting stiffness and crunching levels were 4.0 and 1.8 respectively,
whereas the ending stiffness and crunching levels were 2.0 and 1.2.
Sixty-two percent stated they had greater than 75% pain relief and a
full 100% (eight of eight) had 50% or greater pain relief with
Prolotherapy. In regard to range of motion, before Prolotherapy 89% of
the patients had 74% or less of normal motion, whereas after
Prolotherapy, 75% had 75% or greater of normal motion. Fifty percent had
normal range of motion. (See Figure 10.)
Before Prolotherapy 87% noted an
overall disability of 25% or greater, but this decreased to 13% after
Prolotherapy. Sixty-two percent could walk one block or less before
Prolotherapy, but all of these patients could walk greater than one
block after Prolotherapy. All 100% could only exercise 30 minutes or
less before Prolotherapy, but after Prolotherapy 74% could exercise more
than 30 minutes per day. Before Prolotherapy, 100% were taking pain
medications, but after Prolotherapy 75% were taking no medications.
Since their last Prolotherapy treatment 75% (six of eight) are still not
on any pain medications and the other two patients are just on one
medication. All 100% said that Prolotherapy changed their life for the
better.
Statistical Analysis
A matched sample paired t-test was used to calculate the difference in
responses between the before and after measures for pain, stiffness and
range of motion for the 94 hips, including the subgroup of twenty
patients who before starting Prolotherapy were told there were no other
treatment options and the eight patients told by their medical doctor(s)
there was no other treatment option but surgery. Using the paired
t-test, all p values for pain for all subgroups reached statistical
significance at the p<.0001 level. For the 94 hips, the p values for
pain, stiffness, and range of motion all showed statistically
significant improvements at the p<.0001 level.
Discussion
Principle Findings
The results of this retrospective, uncontrolled, observational study,
show that Prolotherapy helps decrease pain and improve the quality of
life of patients with chronic hip pain. Decreases in pain and stiffness
and improvements in range of motion reached statistical significance
even in patients whose medical doctors said there were no other
treatment options for their hip pain or that surgery was their only
option. Ninety-five percent of patients stated their pain was better
after Prolotherapy. Over 70% said the improvements in their pain,
crunching and stiffness since their last Prolotherapy session have very
much continued (75% or greater). Eighty-nine percent of patients stated
Prolotherapy relieved them of at least 50% of their pain. Fifty-nine
percent received greater than 75% pain relief. Only two patients had
less than 25% of their pain relieved with Prolotherapy.
More than 82% showed improvements in walking ability, exercise ability,
anxiety, depression, sleep and overall disability with Prolotherapy.
Eighty-five percent of patients who were on medications were able to cut
their medication usage by 50% or more after Prolotherapy. They were able
to lessen additional pain management care by 50% or more in 69% of
cases. Ninety-eight percent said that dextrose Prolotherapy changed
their life for the better. (See Table 3.)
strengths and limitations
Our study cannot be compared to a clinical trial in which an
intervention is investigated under controlled conditions. Instead, it is
aimed to document the response of patients with unresolved hip pain to
the Hackett-Hemwall technique of dextrose Prolotherapy at a charity
medical clinic. Clear strengths of the study are the numerous quality of
life parameters that were studied. Quality of life issues such as
walking ability, stiffness, range of motion, activities of daily living,
athletic (exercise) ability, dependency on others, work ability, sleep,
anxiety and depression—in addition to pain level—are important factors
affecting the person with chronic hip pain. Decreases in medication
usage and additional pain management care were also documented. The
improvement in such a large number of hips who were treated solely by
Prolotherapy is likely to have resulted from the treatment. Many of the
above parameters are objective with progress noted in the increased
ability to walk, exercise, work and the need for less medications or
other pain therapies.
The quality of the cases treated in this study is notable. The average
person in this study experienced unresolved hip pain for over five years
and saw over three physicians prior to Prolotherapy treatment.
Twenty-eight (46%) of the patients were either told by their doctor(s)
that there were no other treatment options for their pain or that
surgery was their only option. So clearly this patient population
represented chronic unresponsive hip pain. A follow-up time of nineteen
months since their last treatment session provided a measure of the
long-lasting effect of this modality.
Because this was a charity medical clinic with limited resources and
personnel, the only therapy that was offered was Prolotherapy given
every three months. In private practice, the Hackett-Hemwall technique
of dextrose Prolotherapy is typically given every four to six weeks. If
a patient is not improving or has poor healing ability, the Prolotherapy
solutions may be changed and strengthened or the patient is advised
about additional measures to improve their overall health. This can
include advice on diet, supplements, exercise, weight loss, changes in
medications, additional blood tests, and/or other medical care. Patients
are typically weaned immediately off of
anti-inflammatory and
Narcotic
medications that inhibit the inflammatory response that is needed to
achieve a healing effect from Prolotherapy. Since none of these were
done in this study, the results of this study are expected to be the
least optimum level of success achievable with Hackett-Hemwall dextrose
Prolotherapy. This makes the results even more impressive.
A shortcoming of our study is the subjective nature of some of the
evaluated parameters. Subjective parameters of this sort included pain,
stiffness, anxiety, depression and disability levels. The results relied
on the answers to questions by the patients. Another shortcoming is that
any additional pain management care that they may have been receiving
was not controlled. What was documented was the change in pain levels
with Prolotherapy. There was also a lack of X-ray and
MRI correlation
for diagnosis and response to treatment. A lack of physical examination
documentation in the patients’ charts made categorization of the
patients into various diagnostic parameters impossible.
Potential Implications of Findings
While the exact cause of chronic hip pain is still debated, this study
did show that the Hackett-Hemwall technique of dextrose Prolotherapy
improves not only pain and stiffness levels of those with chronic hip
pain but also a host of other quality of life measures. Current
conventional therapies for unresolved hip pain include medical treatment
with analgesics, non-steroidal antiinflammatory drugs, anti-depressant
medications, steroid shots,
trigger point injections, muscle
strengthening exercises, physiotherapy, weight loss, rest, massage
therapy,
manipulation, orthotics, surgical treatments including total
hip replacement, multidisciplinary group rehabilitation, education and
counseling. The results of such therapies often leave the patients with
residual pain.33-35 Because of this many patients with chronic hip pain
are searching for alternative treatments for their pain.36-37 This is
especially true for those who have been told they need a hip replacement
in the future. They realize that total hip replacement surgeries carry
with them significant risk including prosthesis failure, sciatic nerve
injury, infection, post-op blood clot and potential for continued
pain.38-39 For younger clients especially those under the age of 50, the
notion of a second more complicated revision hip replacement in the
future is not a very appealing prospect.40 Six to 12 months after a hip
joint replacement, pivoting or twisting on the involved leg should be
avoided. As there are over 120 hip replacement systems, the hip
replacement market is driving more and more conservative surgeries.41
Despite much fanfare, there is little scientific evidence of the
purported advantages of minimally invasive joint replacement and hip
resurfacing over conventional joint replacement.42 One of the treatments
that chronic hip pain patients are trying instead of surgery is
Prolotherapy.43
Prolotherapy is the injection of a
solution for the purpose of tightening and strengthening weak tendons,
ligaments or joint capsules. Prolotherapy works by stimulating the body
to repair these soft tissue structures. It starts and accelerates the
inflammatory healing cascade by which
fibroblasts proliferate.
Fibroblasts are the cells through which collagen is made and by which
ligaments and tendons repair. Prolotherapy has been shown in one
double-blinded animal study in a six-week period to increase ligament
mass by 44%, ligament thickness by 27% and the ligament-bone junction
strength by 28%.44 In human studies on
Prolotherapy, biopsies performed after the completion of Prolotherapy
showed significant increases in collagen fiber and ligament diameter of
60%.45-46 This is significant since
degenerative
Osteoarthritis has been in many cases known to be caused by
joint instability caused by
ligament injury.47
Thus, Prolotherapy has the potential to stop the
Degenerative Joint Disease process and some preliminary and anecdotal evidence shows that
in some cases it can reverse it.48-49
(See Figure 11.)
For most cases of chronic hip pain, the
cause of the pain is presumed to be cartilage degeneration. Because the
average person moves his/her hip one million times per year during
activities of daily living, it is no wonder that over time this wear and
tear can begin to break down the joint.50
Besides the pain and disability that degenerative arthritis causes,
there is a tremendous cost. About 20% of the costs result from
ambulatory care services and up to one third from pain medications.
Forty-five percent of costs are hospital charges, as an estimated
400,000 people each year undergo a hip replacement alone.51
The average hospital costs in Chicago per hip replacement is over
$45,000 each. Surgeon and prosthesis costs are between $15,000-18,000
with total costs per hip including hospital stay, surgeons fee, MRI and
X-ray studies and post-operation rehabilitation being over $75,000.52,53
Compare those figures to the average cost per Prolotherapy treatment to
the hip of $300 to $400.54 (See
Table 4.)
If, as in this study, the average
person receives four to five Prolotherapy sessions to complete therapy,
the total cost of Prolotherapy for a chronic hip patient would be on the
order of $1500 to $3000. Thus, each person who received Prolotherapy
instead of a hip replacement would, at minimum, save the health care
system on the order of $72,000. These costs do not include patients
whose hip replacements fail or need to be revised. This also does not
include the lifetime cost savings in medication and ancillary pain
management usage, as well-as the cost savings for patients who would not
need a hip replacement because of the Prolotherapy treatment received.
It has been shown that hip pain is the major predictor of radiographic
hip osteoarthritis that progresses to eventual hip replacement.55 If
this group of patients were to receive Prolotherapy at the start of
their pain, prior to significant radiographic hip osteoarthritis, the
potential cost savings would be tremendous if these patients were to no
longer need a hip replacement. Thus, the actual costs savings over a
lifetime with Hackett-Hemwall dextrose Prolotherapy in patients with
unresolved hip pain would most likely be well in excess of $100,000 per
hip patient. If this occurred for 250,000 patients per year, the cost
savings to the United States health care system could potentially be
over 25 billion dollars per year. Future studies should be done to
determine if indeed Prolotherapy can keep chronic hip pain sufferers
from needing total hip replacements.
Conclusions
The Hackett-Hemwall technique of dextrose Prolotherapy used on patients
who presented with over five years of unresolved hip pain were shown in
this retrospective pilot study to improve their quality of life even 19
months subsequent from their last Prolotherapy session. The 61 patients
with 94 hips treated reported significantly less pain, stiffness,
crunching sensation, disability, depressed and anxious thoughts,
medication and other pain therapy usage, as well as improved walking
ability, range of motion, sleep, exercise ability, and activities of
daily living. This included patients who were told there were no other
treatment options for their pain or that surgery was their only option.
The results confirm that Prolotherapy is a treatment that should be
highly considered for people suffering with chronic hip pain. Future
studies will be needed to confirm this pilot study and to document if
Prolotherapy can keep chronic hip pain sufferers from needing hip
surgeries including hip replacements.
Acknowledgements
Doug Puller (D.P.), independent data collector.
Dave Gruen (D.G.) independent data analyst from www.bolderimage.com.
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