Intra-articular sodium hyaluronate injections in the osteoarthritic ankle joint: Effects, safety and dose dependency

Hyaluronic Acid for the Treatment of Osteoarthritis in all Joints Except the Knee

“…As shown in studies about the intra-articular effects of HA in other joints, it is to be expected that a larger amount of HA or repeated infiltration series have a better effect than a single infiltration regimen. [60,66] However, due to the difficulty of infiltrating, for instance, an amount of 6 mL of HA, because an infiltration of the hip is technically more demanding, and due to the fact that repeating infiltrations of placebo in RCTs is an ethical problem, it is difficult to prove that larger doses and repeated series of HA are better than the amount of HA used in the studies discussed here.…”

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 Osteoarthritis

“…In ankle OA, viscosupplementation demonstrated evidence for signifi cant improvement after 1 and 6 months of fi ve weekly injections in a prospective randomized double-blind trial [ 34 ]. A randomized control trial (RCT) was done by Witteveen et al [ 35 ] of 70 patients who received HA injection into the joint under fl uoroscopy versus distraction in patients with severe OA. There is no signifi cant difference between the two injection methods regarding any of our formulated outcome measures.…”