SLR - April 2012 - Dave Hehemann
Reference: DeGroot H, Uzunishvili S, Weir R, Al-omari A, Gomes B. J Bone Joint Surg Am. 2012; 94:2-8
Scientific Literature Review
Reviewed by: Dave Hehemann, DPM
Residency Program: Cleveland Clinic Foundation/Kaiser Permanente
Podiatric Relevance:
Ankle arthritis is a common affliction encountered by the foot and ankle physician, however conservative treatments are limited. Although hyaluronic acid has been FDA approved for use in the knee, it continues to be considered experimental for use in the ankle. This study compares a single injection of hyaluronic acid to saline in the ankle.
Methods:
A double blinded randomized prospective controlled trial was performed on 64 patients with ankle arthritis. Of the 64 patients, 56 (88 percent) were available for follow-up intervals at six and 12 weeks. Patients either received 2.5 mL of low molecular weight, non-cross-linked sodium hyaluronic acid (Supartz) or 2.5 mL of saline injected through an anterior medial or anterior lateral approach to the ankle. Follow-up was performed by a separate physician as the initial physician would have been aware of the injection solution due to differences in viscosity. Outcomes that were measured at both six and 12 weeks were American Orthopaedic Foot & Ankle Society (AOFAS) score, Ankle Osteoarthritis Scale (AOS) score and visual analog pain scale (VAS).
Results:
At baseline both groups were similar in terms of demographics and measured variables. The experimental group noted an improvement in AOFAS, AOS and VAS scores at six weeks of 4.9, 5.0 and 6.4 respectively. At 12 weeks, improvement was noted to be 4.9, 5.3 and 4.1. The placebo group had a decline in AOFAS and improvements in AOS, VAS scores at 6 weeks of -0.4, 8.4 and 3.0 respectively. At 12 weeks improvement was noted to be 5.4, 14.8 and 11.1.
Conclusions:
Single dose low molecular weight non-cross-linked sodium hyaluronic acid injections may be beneficial for improvement in ankle arthritis, but they were not more efficacious than a single dose injection of saline. Further research needs to be conducted comparing dose regimens as well as hyaluronic acid products for a definitive conclusion on its efficacy of conservatively treating ankle arthritis.