Efficacy of intra-articular hyaluronic acid in patients with osteoarthritis of the ankle: a prospective study

Abstract

Five weekly intra-articular injections of Artz provide pain relief and functional improvements in patients with Kellgren-Lawrence grades I and II ankle OA. The clinical effect was rapid at 1 week and may last for 6 months or more.

Hyaluronic Acid in the Treatment of Osteoarthritis: What is New

“…Clinical benefit was evaluated by means of different scales (Visual Analogic Scale, Ankle Osteoarthritis Scale, American Orthopaedic Foot and Ankle Society, Short Form -12, Short Form -36, Western Ontario and McMaster Universities Osteoarthritis Index), and the follow -up period varied from 6 to 18 months. In studies performed without control group (Hanson et al, 1999;Luciani et al, 2008;MeiDan et al, 2010;Sun et al, 2006;Valiveti et al, 2006;Witteveen et al, 2008Witteveen et al, , 2010 (Table 2), an improvement in all the outcome measures was reported, with the effect lasting for 18 months (Luciani et al, 2008). However, it is not clear from reports whether the pain reduction was clinically significant, or could be ascribed only to a placebo effect.…”

“…Only few studies have been performed in ankle osteoarthritis and, among these, four were randomized / controlled trials (level of evidence 1) (Carpenter & Motley, 2008;Cohen et al, 2008;Karatosun et al, 2008;Salk et al, 2005Salk et al, , 2006, while seven studies (Hanson et al, 1999;Luciani et al, 2008;Mei -Dan et al, 2010;Sun et al, 2006;Valiveti et al, 2006;Witteveen et al, 2008Witteveen et al, , 2010 were case series (level of evidence 4). In all these studies, patients suffering from post -traumatic Kellgreen -Lawrence grade II -IV ankle osteoarthritis were enrolled.…”

“…Another possible reason of the limited benefit of hyaluronic acid can be related to its use mostly in post -traumatic osteoarthritis (Zhang & Jordan, 2010), which has a pathogenesis quite different from that of primary degenerative osteoarthritis. Finally, it must be considered that all studies (Carpenter & Motley, 2008;Hanson et al, 1999;Karatosun et al, 2008;Luciani et al, 2008;Mei -Dan et al, 2010;Salk et al, 2005Salk et al, , 2006Sun et al, 2006;Valiveti et al, 2006;Witteveen et al, 2008Witteveen et al, , 2010, but one (Cohen et al, 2008), were performed blindly, with any imaging guidance. This can be a valid explanation of several unsatisfactory results, because there is evidence that about one third of intraarticular injections are not delivered into the intra -articular cavity, when performed without a visual aid (Cunnington et al, 2010).…”

Ankle arthritis: Diagnosis and conservative management

“…Administration of contrast dye to delineate the joint may be helpful in cases of severe osteoarthritis or in patients with completes varus or valgus deformities 6 . Diagnostic injections with viscosupplementation are less well established and remain more controversial 25,26 . The landmark used for tibiotalar injection is the soft tissue depression between the medial malleolus and the medial border of the tibialis anterior ( Figure 12).…”

“…Although corticosteroid injections remain the golden standard, there are an increased number of research articles examining the role of viscosupplementation with hyaluronate (HA) in ankle arthritis 25,26,36,48 . Currently, in the U.S., HA injections are only FDAapproved for the knee and injections into the ankle, shoulder and hip are considered 'off-label' use 49 .…”