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Wondering if anyone has used Sodium Hyaluronate - or similar product - for ankle OA.
I'd be interested to hear how much you inject, how often and what your results have been.
Thanks
Steve
__________________
DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA
Yes, I've used it in ankles - 1ml every 2 weeks (course of 5) and had OK results (APPROX 50-60% success in pain reduction). However, we usually use it once we've exhausted corticosteroids in patients who don't want surgery.
As an aside, I heard some UK guidelines have questioned the use of hyaluronic acid injections for osteoarthritic joints. Seems they're only good for osteochondral problems (research is working well here on the terminology front - how many OA joints do you see without chondral lesions?). So next time you use ostenil, or the like, in the UK - you might like to write that you're injecting it into a joint for treatment of cartilage degeneration rather than OA on your consent form. Although this could be rubbish. Here's the recommendations of the NICE guideline for OA.
"R31 Intra-articular corticosteroid injections should be considered as an adjunct to core treatment
for the relief of moderate to severe pain in people with osteoarthritis.
R32 Intra-articular hyaluronan injections are not recommended for the treatent of osteoarthritis.
See p 297 for the associated recommendation for future research."
If you've done some cortisone injections with poor results and try Hyalgan and still get 50-60% pain reduction..well....that sounds fairly good to me.
How long does their relief generally last?
It would be nice to have another Tx option for some of these patients. It seems my normal routine has evolved into
1. cortisone injections
2. NSAI / PT
3. ankle scope
I have some orthopedic friends who inject ankles off label with synvisc (and generally "mistakenly" code for the knee!!!) with mixed results.
Thanks
Steve
__________________
DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA
If you've done some cortisone injections with poor results and try Hyalgan and still get 50-60% pain reduction..well....that sounds fairly good to me.
How long does their relief generally last?
Hello Steve,
I suppose it is quite good, but the response in vary varied with some getting a month or 2, more report 6, and a few get upto a year out of it. I think it's probably a good option to offer prior to scoping, especially if they're not keen on surgery, but it's not the be-all and end-all.
Background
To evaluate the safety and efficacy of hylan G-F 20 in patients with ankle osteoarthritis.
Methods
A prospective, open study in patients with symptomatic (≥50 mm and ≤90 mm on a 100 mm VAS) ankle osteoarthritis. Patients received 1 ml × 2 ml intra-articular injection of hylan G-F 20, plus an optional, second injection if pain remained at baseline levels after 1, 2 or 3 months. The primary efficacy endpoint was the change from baseline in the pain VAS score at 3 months.
Results
Fifty-five patients received the first injection; 24 patients received a second. There were no serious or severe adverse events (AEs) related to the treatment. Seventeen patients experienced mild or moderate local, treatment-related AEs. The mean pain VAS score decreased from 68.0 mm (baseline) to 33.8 mm at 3 months (p < 0.001), which was maintained to 6 months (34.2 mm, p < 0.001).
Conclusions
Hylan G-F 20 is well-tolerated and effective for up to 6 months in the treatment of symptomatic ankle osteoarthritis.
hi steve,
about hyaluron, we have not much experienced much with ankle OA,
but, we are giving regularly in your institution, as 2cc intra articular knee,
weekly once for 4 week and also studies have been going on.
patients gets free treatment.
The use of intra-articular injections of high molecular weight elastoviscous solutions of hyaluronan or hylans (cross-linked derivatives of hyaluronan) to treat arthritis is termed viscosupplementation. The function of viscosupplementation is to restore the rheologic properties of synovial fluid. Although anecdotal data exist, no long-term studies regarding the use of viscosupplementation in the ankle have been published to date. The goal of this clinical trial was to compare pain reduction following ankle arthroscopy versus that following ankle arthroscopy combined with weekly intra-articular instillation of hylan G-F 20 during the first 3 postoperative weeks. In the series of patients described in this report, we found that both treatment groups experienced statistically significantly decreased pain following the intervention (P = .002 and P = .0009 for the arthroscopy alone and arthroscopy plus hylan groups, respectively), and that those who received 3 intra-articular injections of hylan G-F 20 following ankle arthroscopy improved statistically significantly (P = .0014) more than did those who underwent arthroscopy as a sole therapy. These preliminary results suggest that viscosupplementation combined with arthroscopy may be more beneficial than arthroscopy alone, and provide further insight into the role of viscosupplementation in the treatment of ankle osteoarthritis
Intra-articular injection of hyaluronic Acid is not superior to saline solution injection for ankle arthritis: a randomized, double-blind, placebo-controlled study.
Degroot H, Uzunishvili S, Weir R, Al-Omari A, Gomes B. J Bone Joint Surg Am. 2012 Jan 4;94(1):2-8.
Quote:
BACKGROUND:
Intra-articular injections of hyaluronic acid are potentially useful to treat ankle osteoarthritis, yet their effectiveness has not been proven. Both single and multiple-dose treatments for ankle arthritis with use of various hyaluronic acid products have been recommended, but few high-quality studies have been published. The aim of this study was to compare the effectiveness of a single intra-articular injection of hyaluronic acid with a single intra-articular injection of normal saline solution (placebo) for osteoarthritis of the ankle.
METHODS:
Sixty-four patients with ankle osteoarthritis who met all study criteria were randomly assigned to a single intra-articular injection of 2.5 mL of low-molecular-weight, non-cross-linked hyaluronic acid or a single intra-articular injection of 2.5 mL of normal saline solution. The primary outcome measure was the change from baseline in the American Orthopaedic Foot & Ankle Society (AOFAS) clinical rating score at the six-week and twelve-week follow-up examination. Secondary outcome measures included the Ankle Osteoarthritis Scale score and patient-reported pain with use of a visual analog pain scale.
RESULTS:
Of the sixty-four patients randomized and treated, eight patients withdrew, leaving fifty-six patients who completed the entire study. There was one mild adverse event (1.6%) among the sixty-four patients. At six weeks and twelve weeks, the mean AOFAS scores in the hyaluronic acid group had improved from baseline by 4.9 and 4.9 points, respectively, whereas the mean AOFAS scores in the placebo group initially worsened by 0.4 point at six weeks and then improved by 5.4 points at twelve weeks. While the change at twelve weeks from baseline was substantial for both groups, the between-group differences were not significant.
CONCLUSIONS:
We found that a single intra-articular injection of low-molecular-weight, non-cross-linked hyaluronic acid is not demonstrably superior to a single intra-articular injection of saline solution for the treatment of osteoarthritis of the ankle.
Hyalgan (Hyaluronan) for Ankles
). So next time you use ostenil, or the like, in the UK - you might like to write that you're injecting it into a joint for treatment of cartilage degeneration rather than OA on your consent form. Although this could be rubbish. Here's the recommendations of the NICE guideline for OA.
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