Dual Intra-articular injections of corticosteroid and hyaluronic acid are more effective than corticosteroid alone for ankle osteoarthritis

Abstract

An intra-articular corticosteroid injection is commonly administered to relieve pain for ankle osteoarthritis (OA). Corticosteroid effects are short-lived, whereas, hyaluronic acid (HA) has longer effects. We hypothesized that intra-articular injections of corticosteroid and HA would be more effective than corticosteroid alone. A randomized controlled trial was decided to investigate the hypothesis. 135 patients with OA were gathered to an intra-articular corticosteroid injection group (CS group, n = 61) or dual HA plus corticosteroid injection group (CS + HA group, n = 74). The CS group received a corticosteroid injection of 1 ml once, and the CS + HA group received 2 ml of HA and 1 ml corticosteroid on the first week, followed by 2 ml of HA on the second and third weeks. Clinical evaluations were performed before injection (baseline), 6 and 12 weeks after first injections. The Ankle Osteoarthritis Scale (AOS) was used as the primary outcome measure, and the Visual Analog Scale (VAS), Short Form health survey (SF-36), and complications used as secondary outcomes. The CS + HA group had better primary outcomes than the CS group. Remarkable secondary outcomes improvements were obtained in both groups. No complications were reported. We conclude that the corticosteroid and HA combination injection is more effective in relieving pain for ankle OA than corticosteroid alone.