• 1

    Gerwin N, Hops C, Lucke A: Intraarticular drug delivery in osteoarthritis. .Adv Drug Deliv Rev 58::226. ,2006. .

  • 2

    Haq I, Murphy E, Dacre J: Osteoarthritis. .Postgrad Med J 79::377. ,2003. .

  • 3

    Peat G, McCarney R, Croft P: Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. .Ann Rheum Dis 60::91. ,2001. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Thomas RH, Daniels TR: Ankle arthritis. .J Bone Joint Surg Am 85::923. ,2003. .

  • 5

    Feder KS, Schonholtz GJ: Ankle arthroscopy: review and long-term results. .Foot Ankle 13::382. ,1992. .

  • 6

    Amendola A, Petrik J, Webster-Bogaert S: Ankle arthroscopy: outcome in 79 consecutive patients. .Arthroscopy 12::565. ,1996. .

  • 7

    Kopp FJ, Patel MM, Deland JT, et al: Total ankle arthroplasty with the agility prosthesis: clinical and radiographic evaluation. .Foot Ankle Int 27::97. ,2006. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Coester LM, Saltzman CL, Leupold J, et al: Long-term results following ankle arthrodesis for post-traumatic arthritis. .J Bone Joint Surg Am 83::219. ,2001. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Schuberth JM, Patel S, Zarutsky E: Perioperative complications of the agility total ankle replacement in 50 initial, consecutive cases. .J Foot Ankle Surg 45::139. ,2006. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Balazs EA: Use of hyaluronic acid in eye surgery [in French]. .Annee Ther Clin Ophtalmol 33::95. ,1982. .

  • 11

    Balazs EA, Laurent TC, Jeanloz RW: Nomenclature of hyaluronic acid. .Biochem J 235::903. ,1986. .

  • 12

    Balazs EA: Viscosupplementation for treatment of osteoarthritis: from initial discovery to current status and results. .Surg Technol Int 12::278. ,2004. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Balazs EA, Hogberg B, Laurent TC: The biological activity of hyaluron sulfuric acid. .Acta Physiol Scand 23::168. ,1951. .

  • 14

    Larsen NE, Leshchiner EA, Parent EG, et al: Hylan gel composition for percutaneous embolization. .J Biomed Mater Res 25::699. ,1991. .

  • 15

    Rydell N, Balazs EA: Effect of intra-articular injection of hyaluronic acid on the clinical symptoms of osteoarthritis and on granulation tissue formation. .Clin Orthop Relat Res 80::25. ,1971. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    St Onge R, Weiss C, Denlinger JL, et al: A preliminary assessment of Na-hyaluronate injection into “no man’s land” for primary flexor tendon repair. .Clin Orthop Relat Res 146::269. ,1980. .

    • Search Google Scholar
    • Export Citation
  • 17

    Migliore A, Tormenta S, Massafra U, et al: Repeated ultrasound-guided intra-articular injections of 40 mg of Hyalgan may be useful in symptomatic relief of hip osteoarthritis. .Osteoarthritis Cartilage 13::1126. ,2005. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Moskowitz RW, Blaine TA: An overview of treatment options for persistent shoulder pain. .Am J Orthop 34: (suppl):10. ,2005. .

  • 19

    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 33::951. ,2006. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Salk RS, Chang TJ, D’Costa WF, et al: Sodium hyaluronate in the treatment of osteoarthritis of the ankle: a controlled, randomized, double-blind pilot study. .J Bone Joint Surg Am 88::295. ,2006. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Stahl S, Karsh-Zafrir I, Ratzon N, et al: Comparison of intraarticular injection of depot corticosteroid and hyaluronic acid for treatment of degenerative trapeziometacarpal joints. .J Clin Rheumatol 11::299. ,2005. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Waddell DD, Bricker DC: Clinical experience with the effectiveness and tolerability of hylan G-F 20 in 1047 patients with osteoarthritis of the knee. .J Knee Surg 19::19. ,2006. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Laurent TC, Fraser JR: Hyaluronan. .FASEB J 6::2397. ,1992. .

  • 24

    Swann DA: “Macromolecules of Synovial Fluid,” in The Joints and Synovial Fluid, ed by L Sokoloff, p 407, Academic Press, New York. ,1978–80. .

  • 25

    Balazs EA, Watson D, Duff IF, et al: Hyaluronic acid in synovial fluid: I. Molecular parameters of hyaluronic acid in normal and arthritis human fluids. .Arthritis Rheum 10::357. ,1967. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Peyron JG: A new approach to the treatment of osteoarthritis: viscosupplementation. .Osteoarthritis Cartilage 1::85. ,1993. .

  • 27

    Abatangelo G, O’Regan M: Hyaluronan: biological role and function in articular joints. .Eur J Rheumatol Inflamm 151::9. ,1995. .

  • 28

    Kitaoka H, Alexander I, Adelaar R, et al: Clinical rating systems for ankle-hindfoot, midfoot, hallux and lesser toes. .Foot Ankle Int 15::349. ,1994. .

  • 29

    Domsic RT, Saltzman CL: Ankle osteoarthritis scale. .Foot Ankle Int 19::466. ,1998. .

  • 30

    Kellgren JH, Lawrence JS: Radiological assessment of osteoarthrosis. .Ann Rheum Dis 16::494. ,1957. .

  • 31

    Adams ME, Atkinson MH, Lussier AJ, et al: The role of viscosupplementation with hylan G-F 20 (Synvisc) in the treatment of osteoarthritis of the knee: a Canadian multicenter trial comparing hylan G-F 20 alone, hylan G-F 20 with non-steroidal anti-inflammatory drugs (NSAIDs) and NSAIDs alone. .Osteoarthritis Cartilage 3::213. ,1995. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Bertolami CN, Gay T, Clark GT, et al: Use of sodium hyaluronate in treating temporomandibular joint disorders: a randomized, double-blind, placebo-controlled clinical trial. .J Oral Maxillofac Surg 51::232. ,1993. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33

    Sun SF, Chou YJ, Hsu CW, et al: Efficacy of intra-articular hyaluronic acid in patients with osteoarthritis of the ankle: a prospective study. .Osteoarthritis Cartilage 14::867. ,2006. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Wang CT, Lin J, Chang CJ, et al: Therapeutic effects of hyaluronic acid on osteoarthritis of the knee: a meta-analysis of randomized controlled trials. .J Bone Joint Surg Am 86::538. ,2004. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35

    Forsey RW, Fisher J, Thompson J, et al: The effect of hyaluronic acid and phospholipid based lubricants on friction within a human cartilage damage model. .Biomaterials 27::4581. ,2006. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36

    Altman RD, Moskowitz R; Hyalgan Study Group: Intraarticular sodium hyaluronate (Hyalgan) in the treatment of patients with osteoarthritis of the knee: a randomized clinical trial [published correction appears in J Rheumatol 26: 1216, 1999]. .J Rheumatol 25::2203. ,1998. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Fraser JR, Laurent TC, Laurent UB: Hyaluronan: its nature, distribution, functions and turnover [review]. .J Intern Med 242::27. ,1997. .

  • 38

    Fraser JR, Kimpton WG, Pierscionek BK, et al: The kinetics of hyaluronan in normal and acutely inflamed synovial joints: observations with experimental arthritis in sheep. .Semin Arthritis Rheum 22: (suppl 1):9. ,1993. .

    • PubMed
    • Search Google Scholar
    • Export Citation

Treatment of Osteoarthritis of the Ankle by Intra-articular Injections of Hyaluronic Acid

A Prospective Study

Omer Mei-Dan Department of Orthopedic Surgery, Meir University Hospital, Kfar-Saba, Israel.

Search for other papers by Omer Mei-Dan in
Current site
Google Scholar
PubMed
Close
 MD
,
Beni Kish Department of Orthopedic Surgery, Meir University Hospital, Kfar-Saba, Israel.

Search for other papers by Beni Kish in
Current site
Google Scholar
PubMed
Close
 MD
,
Shai Shabat Department of Orthopedic Surgery, Meir University Hospital, Kfar-Saba, Israel.

Search for other papers by Shai Shabat in
Current site
Google Scholar
PubMed
Close
 MD
,
Sabri Masarawa Department of Orthopedic Surgery, Meir University Hospital, Kfar-Saba, Israel.

Search for other papers by Sabri Masarawa in
Current site
Google Scholar
PubMed
Close
 MD
,
Avi Shteren Department of Orthopedic Surgery, Meir University Hospital, Kfar-Saba, Israel.

Search for other papers by Avi Shteren in
Current site
Google Scholar
PubMed
Close
 MD
,
Gideon Mann Department of Orthopedic Surgery, Meir University Hospital, Kfar-Saba, Israel.
Ribstein Center for Sport Medicine Sciences and Research, Wingate Institute, Netanya, Israel.

Search for other papers by Gideon Mann in
Current site
Google Scholar
PubMed
Close
 MD
, and
Meir Nyska Department of Orthopedic Surgery, Meir University Hospital, Kfar-Saba, Israel.

Search for other papers by Meir Nyska in
Current site
Google Scholar
PubMed
Close
 MD
Restricted access

Background: Treatment of osteoarthritis of the ankle is similar to that of any other large joint and includes conservative and surgical options. Surgical treatment in severe cases is fusion or joint replacement, whereas conservative treatment is limited and includes mainly ankle supports and physiotherapy. Hyaluronic acid was discovered by Meyer and Palmer in 1934 and has recently been widely used in the treatment of knee osteoarthritis. We evaluated the efficacy of an intra-articular preparation containing sodium hyaluronate in the treatment of osteoarthritis of the ankle.

Methods: We studied 16 patients aged 31 to 79 years (mean age, 43 years) with symptomatic ankle osteoarthritis of 9 months' to 27 years' duration. The radiographic severity of the ankle osteoarthritis was graded II, III, or IV according to Kellgren and Lawrence. Arthritic ankles underwent intra-articular injections of 25 mg of sodium hyaluronate for 5 consecutive weeks. Follow-up visits were performed 4, 8, 11, 17, and 32 weeks after treatment and included clinical evaluation and objective scoring.

Results: Global assessment showed improvement in 13 of 15 patients who completed the study. There was improvement by 20% in range of motion and a significant reduction in pain assessed by visual analog scale and ankle-hindfoot scores, all statistically significant. Seven months after treatment, no decrease in efficacy was shown. Two patients did not show any significant improvement in global assessment after treatment. One patient was dropped from follow-up owing to concurrent back surgery.

Conclusions: Symptomatic relief of signs and symptoms of osteoarthritis of the ankle was achieved by injection of an intra-articular preparation containing sodium hyaluronate. There were significant improvements, in objective and subjective parameters, that lasted for more than 7 months. Ankle intra-articular injection of sodium hyaluronate is a valid conservative treatment for ankle osteoarthritis. (J Am Podiatr Med Assoc 100(2): 93–100, 2010)

Corresponding author: Omer Mei-Dan, MD, Department of Orthopedic Surgery, Meir University Hospital, Tchernichovski St 59, Kfar-Saba, Israel. (E-mail: omer@extremegate.com)