Browse > Article
http://dx.doi.org/10.14193/jkfas.2022.26.2.71

The Efficacy of Intra-Articular Hyaluronic Acid Injections in Ankle Osteoarthritis  

Park, Chul Hyun (Department of Orthopaedic Surgery, College of Medicine, Yeungnam University)
Park, Jeong Jin (Department of Orthopaedic Surgery, Yeungnam University Medical Center)
Seok, Hyun Gyu (Department of Orthopaedic Surgery, Yeungnam University Medical Center)
Woo, In Ha (Department of Orthopaedic Surgery, Yeungnam University Medical Center)
Publication Information
Journal of Korean Foot and Ankle Society / v.26, no.2, 2022 , pp. 71-77 More about this Journal
Abstract
Purpose: This study sought to investigate the appropriate indications for intra-articular injection of hyaluronic acid in ankle osteoarthritis, its efficacy at each stage of osteoarthritis and to compare the efficacy related differences at each stage. Materials and Methods: A retrospective study was conducted from January 2016 to September 2019 on 43 patients (50 cases) diagnosed with ankle arthritis and given intra-articular injection of hyaluronic acid. Patients were classified according to the modified Takakura ankle osteoarthritis stages. Stage 2 comprised 24 cases; stage 3A, 15 cases; stage 3B, 8 cases; and stage 4, 3 cases. The clinical evaluation was carried out using the visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, and the Foot and Ankle Outcome Score (FAOS). The patients' satisfaction with the injection was evaluated at 1 year after injection. A radiographic evaluation was performed to gauge the progression of osteoarthritis before and after the injection. Results: The VAS, AOFAS score, and FAOS at 3 months and 1 year after injection showed statistically significant improvements compared to those before the injection. There was a significant difference in the VAS for each stage over time; however, this was not the case with the AOFAS score and the FAOS. A significant improvement of the VAS after injection was seen only in stage 3A when compared with the other stages. The overall satisfaction rate with the injection was 90%. There were no ankle osteoarthritic stage changes in the serial follow-up radiograph. Conclusion: Intra-articular injection of hyaluronic acid resulted in a significant clinical improvement up to 1 year after the injection. Therefore, the intra-articular injection of hyaluronic acid could be a treatment option for ankle osteoarthritis.
Keywords
Ankle; Osteoarthritis; Hyaluronic acid; Injections;
Citations & Related Records
Times Cited By KSCI : 1  (Citation Analysis)
연도 인용수 순위
1 Witteveen AG, Hofstad CJ, Kerkhoffs GM. Hyaluronic acid and other conservative treatment options for osteoarthritis of the ankle. Cochrane Database Syst Rev. 2015;(10):CD010643. doi: 10.1002/14651858.CD010643.pub2.   DOI
2 Juni P, Hari R, Rutjes AW, Fischer R, Silletta MG, Reichenbach S, et al. Intra-articular corticosteroid for knee osteoarthritis. Cochrane Database Syst Rev. 2015;2015:CD005328. doi: 10.1002/14651858.CD005328.pub3.   DOI
3 Mei-Dan O, Kish B, Shabat S, Masarawa S, Shteren A, Mann G, et al. Treatment of osteoarthritis of the ankle by intra-articular injections of hyaluronic acid: a prospective study. J Am Podiatr Med Assoc. 2010;100:93-100. doi: 10.7547/1000093.   DOI
4 Tanaka Y, Takakura Y, Hayashi K, Taniguchi A, Kumai T, Sugimoto K. Low tibial osteotomy for varus-type osteoarthritis of the ankle. J Bone Joint Surg Br. 2006;88:909-13. doi: 10.1302/0301-620X.88B7.17325.   DOI
5 Hogan MV, Mani SB, Chan JY, Do H, Deland JT, Ellis SJ. Validation of the Foot and Ankle Outcome Score for hallux rigidus. HSS J. 2016;12:44-50. doi: 10.1007/s11420-015-9466-4.   DOI
6 Sevastik J, Lemperg R. [Local bone destruction after intra-articular injection of corticosteroids]. Nord Med. 1969;81:949-51. Swedish.
7 Vannabouathong C, Del Fabbro G, Sales B, Smith C, Li CS, Yardley D, et al. Intra-articular injections in the treatment of symptoms from ankle arthritis: a systematic review. Foot Ankle Int. 2018;39:1141-50. doi: 10.1177/1071100718779375.   DOI
8 Meheux CJ, McCulloch PC, Lintner DM, Varner KE, Harris JD. Efficacy of intra-articular platelet-rich plasma injections in knee osteoarthritis: a systematic review. Arthroscopy. 2016;32:495-505. doi: 10.1016/j.arthro.2015.08.005.   DOI
9 Behrens F, Shepard N, Mitchell N. Alterations of rabbit articular cartilage by intra-articular injections of glucocorticoids. J Bone Joint Surg Am. 1975;57:70-6.   DOI
10 Wang CT, Lin J, Chang CJ, Lin YT, Hou SM. Therapeutic effects of hyaluronic acid on osteoarthritis of the knee. A meta-analysis of randomized controlled trials. J Bone Joint Surg Am. 2004;86:538-45. doi: 10.2106/00004623-200403000-00012.   DOI
11 Gupta RC, Lall R, Srivastava A, Sinha A. Hyaluronic acid: molecular mechanisms and therapeutic trajectory. Front Vet Sci. 2019;6:192. doi: 10.3389/fvets.2019.00192.   DOI
12 Smith C, Patel R, Vannabouathong C, Sales B, Rabinovich A, McCormack R, et al. Combined intra-articular injection of corticosteroid and hyaluronic acid reduces pain compared to hyaluronic acid alone in the treatment of knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2019;27:1974-83. doi: 10.1007/s00167-018-5071-7.   DOI
13 Sun SF, Hsu CW, Sun HP, Chou YJ, Li HJ, Wang JL. The effect of three weekly intra-articular injections of hyaluronate on pain, function, and balance in patients with unilateral ankle arthritis. J Bone Joint Surg Am. 2011;93:1720-6. doi: 10.2106/JBJS.J.00315.   DOI
14 Kim JB, Yi Y, Kim JY, Cho JH, Kwon MS, Choi SH, et al. Weightbearing computed tomography findings in varus ankle osteoarthritis: abnormal internal rotation of the talus in the axial plane. Skeletal Radiol. 2017;46:1071-80. doi: 10.1007/s00256-017-2655-0.   DOI
15 Song JH, Kang C, Kim TG, Lee GS, Lee JK, Ahn KJ, et al. Perioperative axial loading computed tomography findings in varus ankle osteoarthritis: effect of supramalleolar osteotomy on abnormal internal rotation of the talus. Foot Ankle Surg. 2021;27:217-23. doi: 10.1016/j.fas.2020.04.006.   DOI
16 Petrella RJ, Petrella M. A prospective, randomized, double-blind, placebo controlled study to evaluate the efficacy of intraarticular hyaluronic acid for osteoarthritis of the knee. J Rheumatol. 2006;33:951-6.
17 Witteveen AG, Sierevelt IN, Blankevoort L, Kerkhoffs GM, van Dijk CN. Intra-articular sodium hyaluronate injections in the osteoarthritic ankle joint: effects, safety and dose dependency. Foot Ankle Surg. 2010;16:159-63. doi: 10.1016/j.fas.2009.10.003.   DOI
18 Cohen MM, Altman RD, Hollstrom R, Hollstrom C, Sun C, Gipson B. Safety and efficacy of intra-articular sodium hyaluronate (Hyalgan) in a randomized, double-blind study for osteoarthritis of the ankle. Foot Ankle Int. 2008;29:657-63. doi: 10.3113/FAI.2008.0657.   DOI
19 Lee DH, Kim TH, Han SH. Efficacy of intra-articular hyaluronic acid injection in early stage ankle osteoarthritis. J Korean Foot Ankle Soc. 2011;15:27-31.
20 Boffa A, Previtali D, Di Laura Frattura G, Vannini F, Candrian C, Filardo G. Evidence on ankle injections for osteochondral lesions and osteoarthritis: a systematic review and meta-analysis. Int Orthop. 2021;45:509-23. doi: 10.1007/s00264-020-04689-5.   DOI
21 Salk RS, Chang TJ, D'Costa WF, Soomekh DJ, Grogan KA. Sodium hyaluronate in the treatment of osteoarthritis of the ankle: a controlled, randomized, double-blind pilot study. J Bone Joint Surg Am. 2006;88:295-302. doi: 10.2106/JBJS.E.00193.   DOI
22 Evanich JD, Evanich CJ, Wright MB, Rydlewicz JA. Efficacy of intraarticular hyaluronic acid injections in knee osteoarthritis. Clin Orthop Relat Res. 2001;(390):173-81. doi: 10.1097/00003086-200109000-00020.   DOI
23 Altman RD, Moskowitz R. Intraarticular sodium hyaluronate (Hyalgan) in the treatment of patients with osteoarthritis of the knee: a randomized clinical trial. Hyalgan Study Group. J Rheumatol. 1998;25:2203-12. Erratum in: J Rheumatol. 1999;26:1216.
24 Lee GW, Kwak WK, Lee KB. Effects and safety of intra-articular sodium hyaluronate injection for the treatment of ankle osteoarthritis: a prospective clinical trial. J Foot Ankle Surg. 2022;61:345-9. doi: 10.1053/j.jfas.2021.09.012.   DOI
25 Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. 1994;15:349-53. doi: 10.1177/107110079401500701.   DOI
26 Mankin HJ, Conger KA. The acute effects of intra-articular hydrocortisone on articular cartilage in rabbits. J Bone Joint Surg Am. 1966;48:1383-8.   DOI
27 Creamer P, Hochberg MC. Osteoarthritis. Lancet. 1997;350:503-8. doi: 10.1016/S0140-6736(97)07226-7.   DOI
28 He WW, Kuang MJ, Zhao J, Sun L, Lu B, Wang Y, et al. Efficacy and safety of intraarticular hyaluronic acid and corticosteroid for knee osteoarthritis: a meta-analysis. Int J Surg. 2017;39:95-103. doi: 10.1016/j.ijsu.2017.01.087.   DOI
29 Bowman EN, Hallock JD, Throckmorton TW, Azar FM. Hyaluronic acid injections for osteoarthritis of the knee: predictors of successful treatment. Int Orthop. 2018;42:733-40. doi: 10.1007/s00264-017-3731-8.   DOI