Imaging Guidance Improves the Results of Viscosupplementation with HANOX-M-XL in Patients with Ankle Osteoarthritis: Results of a Clinical Survey in 50 Patients Treated in Daily Practice

Abstract

BACKGROUNDThe objective of this survey was to assess retrospectively the interest of performing viscosupplementation using imaging guidance in patients suffering from ankle osteoarthritis (OA).PATIENTS AND METHODSThis is a multicenter retrospective survey using a standardized questionnaire. Fifty patients suffering from ankle OA and treated, in daily clinical practice, with a single intra-articular injection of a novel viscosupplement made of a combination of a non-animal cross-linked hyaluronan and mannitol, HANOX M-XL, were included in the survey. The injection procedure (imaging or landmark guidance), demographic data, patient’s self-evaluation of pain, satisfaction, treatment efficacy, and tolerability were collected. Predictive factors of both efficacy and patient’s satisfaction were investigated.RESULTSThe percentages of patients very satisfied/satisfied and not really satisfied/dissatisfied with the treatment were 68% and 32%, respectively. Efficacy was rated as very good, good, moderate, and poor by 38%, 30%, 12%, and 20% of the cases, respectively. Efficacy was unrelated to gender and age and was highly correlated with pain score (P < 0.0001). In satisfied patients, the decrease in consumption of analgesics/non-steroidal anti-inflammatory drugs was >75% in 64% of the cases. Efficacy was significantly different with regard to imaging guidance. There was a statistically significant difference in efficacy and satisfaction between landmark-guided and imaging-guided injections (P = 0.02). The success rate was 2.3 times higher in the imaging-guided group than in the landmark-guided group. No significant difference was found between patients injected under fluoroscopy or ultrasound guidance, despite a trend favoring ultrasound (P = 0.09). Tolerability was rated as very good/good in 47 patients, moderate in two, and poor in one and was unrelated to the type of guidance.CONCLUSIONThis preliminary study suggests that the use of imaging guidance significantly optimizes the success rate of ankle viscosupplementation. No safety concern was observed.LEVEL OF EVIDENCEIII.

EUROVISCO Recommendations for Optimizing the Clinical Results of Viscosupplementation in Osteoarthritis

“…Here again it has been evidenced that the accuracy of the needle positioning, consequently of the IA injection, may influence the clinical outcomes of viscosupplementation. 27,28 This is easily understandable because HA does not have a systemic but a local effect and cannot diffuse into the intraarticular space if injected extraarticularly. The first part of the work was dedicated to the clinical and anatomical factors that may influence the treatment efficacy in knee OA.…”

Hyaluronic acid preparations in the treatment of osteoarthritis: is it clear to us?

“…Имеются данные о возможности использования ГлК при лечении ОА голеностопного сустава [75][76][77]. Оценка применения ГлК при этой локализации ОА была проведена T.В.…”

Intra-articular Injections in the Treatment of Symptoms from Ankle Arthritis: A Systematic Review

“…12,30 Ankle arthritis may also be caused by other factors, such as rheumatoid arthritis (RA) or hemophilic arthropathy. [3][4][5][6]13 Nonoperative therapies, such as analgesics, oral nonsteroidal anti-inflammatory drugs, orthotics, and physical therapy, can have considerable side effects or lose their effect over time. 3,5,6,20 There is a need for additional treatment options that can delay or avoid costly surgery, help patients with their symptoms, and potentially preserve the joint for future operative intervention, if needed.…”

“…[3][4][5][6]13 Nonoperative therapies, such as analgesics, oral nonsteroidal anti-inflammatory drugs, orthotics, and physical therapy, can have considerable side effects or lose their effect over time. 3,5,6,20 There is a need for additional treatment options that can delay or avoid costly surgery, help patients with their symptoms, and potentially preserve the joint for future operative intervention, if needed. 3,5,6,20,21 Intra-articular (IA) injections are used to manage arthritis in other major joints, and it has been hypothesized that patients with ankle arthritis may also benefit from these treatments.…”