Yonsei Med J.  2014 Jul;55(4):1080-1086. 10.3349/ymj.2014.55.4.1080.

Prognostic Factors after Intra-Articular Hyaluronic Acid Injection in Ankle Osteoarthritis

• Han SH
• Park DY
• Kim TH

• KMID: 2130836
• DOI: http://doi.org/10.3349/ymj.2014.55.4.1080

Abstract

PURPOSE
The goal of this study was to identify baseline prognostic factors of outcome in ankle osteoarthritis patients after intra-articular hyaluronic acid injection.
MATERIALS AND METHODS
Patients with ankle osteoarthritis who received hyaluronic acid injection therapy were retrospectively reviewed. Each patient received weekly intra-articular hyaluronic acid injections (2 mL) for 3 weeks. Six predictors including gender, age, symptom duration, radiographic osteoarthritis stage, radiographic subchondral cyst, and fracture history were evaluated. Visual analogue scale (VAS) and patient satisfaction were evaluated as outcome measures. These predictors and outcome measurements were included in a logistic regression model for statistical analysis.
RESULTS
Total of 40 consecutive patients (21 male, 19 female) were included in this study. Mean age was 60.6. Average follow up period was 13 months. The mean VAS recorded 3, 6, and 12 months after the first injection was 3.6 (SD 2.54, p<0.001), 4.33 (SD 2.9, p<0.001), and 5.3 (SD 2.7, p=0.0071), respectively, when compared to baseline VAS. Early stage disease was identified as an independent predictor associated with 'positive VAS outcome' at 3 and 6 months. Early stage disease and duration of pain less than 1 year were independent predictors associated with higher satisfaction.
CONCLUSION
While hyaluronic acid injection for ankle osteoarthritis is a safe and effective treatment, careful selection of patients should be made according to the above prognostic predictors.

Keyword

Ankle; osteoarthritis; hyaluronic acid; prognosis

MeSH Terms

Adult
Aged
Aged, 80 and over
Ankle Joint/drug effects/*pathology/*physiopathology
Female
Humans
Hyaluronic Acid/administration & dosage/*therapeutic use
*Injections, Intra-Articular
Male
Middle Aged
Osteoarthritis/*drug therapy/pathology/physiopathology
Prognosis
Range of Motion, Articular/physiology
Hyaluronic Acid

Figure

• 

  Fig. 1 Histogram of VAS change according to time. (A) Short term changes after intra-articular HA injection. (B) Long term changes after intra-articular HA injection, compared to baseline VAS. Baseline, before injection; Week 1, 1 week after first injection; Week 2, 1 week after second injection; Week 3, 1 week after third injection; VAS, visual analogue scale; HA, hyaluronic acid.

Reference

1. Cushnaghan J, Dieppe P. Study of 500 patients with limb joint osteoarthritis. I. Analysis by age, sex, and distribution of symptomatic joint sites. Ann Rheum Dis. 1991; 50:8–13.

2. Saltzman CL, Salamon ML, Blanchard GM, Huff T, Hayes A, Buckwalter JA, et al. Epidemiology of ankle arthritis: report of a consecutive series of 639 patients from a tertiary orthopaedic center. Iowa Orthop J. 2005; 25:44–46.

3. Brown TD, Johnston RC, Saltzman CL, Marsh JL, Buckwalter JA. Posttraumatic osteoarthritis: a first estimate of incidence, prevalence, and burden of disease. J Orthop Trauma. 2006; 20:739–744.

4. Horisberger M, Valderrabano V, Hintermann B. Posttraumatic ankle osteoarthritis after ankle-related fractures. J Orthop Trauma. 2009; 23:60–67.

5. Agel J, Coetzee JC, Sangeorzan BJ, Roberts MM, Hansen ST Jr. Functional limitations of patients with end-stage ankle arthrosis. Foot Ankle Int. 2005; 26:537–539.

6. van Dijk CN, Tol JL, Verheyen CC. A prospective study of prognostic factors concerning the outcome of arthroscopic surgery for anterior ankle impingement. Am J Sports Med. 1997; 25:737–745.

7. Migliore A, Giovannangeli F, Bizzi E, Massafra U, Alimonti A, Laganà B, et al. Viscosupplementation in the management of ankle osteoarthritis: a review. Arch Orthop Trauma Surg. 2011; 131:139–147.

8. Lo GH, LaValley M, McAlindon T, Felson DT. Intra-articular hyaluronic acid in treatment of knee osteoarthritis: a meta-analysis. JAMA. 2003; 290:3115–3121.

9. Gaston MS, Tiemessen CH, Philips JE. Intra-articular hip viscosupplementation with synthetic hyaluronic acid for osteoarthritis: efficacy, safety and relation to pre-injection radiographs. Arch Orthop Trauma Surg. 2007; 127:899–903.

10. Labbe M, Ridgeland E, Savoie FH. The short-term efficacy of hyaluronic acid injections for the treatment of degenerative arthrosis of the shoulder. Arthroscopy. 2003; 19:S13–S18.

11. Balazs EA, Denlinger JL. Viscosupplementation: a new concept in the treatment of osteoarthritis. J Rheumatol Suppl. 1993; 39:3–9.

12. 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.

13. Sun SF, Chou YJ, Hsu CW, Hwang CW, Hsu PT, Wang JL, et al. Efficacy of intra-articular hyaluronic acid in patients with osteoarthritis of the ankle: a prospective study. Osteoarthritis Cartilage. 2006; 14:867–874.

14. Takakura Y, Tanaka Y, Kumai T, Tamai S. Low tibial osteotomy for osteoarthritis of the ankle. Results of a new operation in 18 patients. J Bone Joint Surg Br. 1995; 77:50–54.

15. Witteveen AG, Giannini S, Guido G, Jerosch J, Lohrer H, Vannini F, et al. A prospective multi-centre, open study of the safety and efficacy of hylan G-F 20 (Synvisc) in patients with symptomatic ankle (talo-crural) osteoarthritis. Foot Ankle Surg. 2008; 14:145–152.

16. 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; 29:657–663.

17. Carpenter B, Motley T. The role of viscosupplementation in the ankle using hylan G-F 20. J Foot Ankle Surg. 2008; 47:377–384.

18. Luciani D, Cadossi M, Tesei F, Chiarello E, Giannini S. Viscosupplementation for grade II osteoarthritis of the ankle: a prospective study at 18 months' follow-up. Chir Organi Mov. 2008; 92:155–160.

19. Bannuru RR, Natov NS, Dasi UR, Schmid CH, McAlindon TE. Therapeutic trajectory following intra-articular hyaluronic acid injection in knee osteoarthritis--meta-analysis. Osteoarthritis Cartilage. 2011; 19:611–619.

20. van Dijk CN, Reilingh ML, Zengerink M, van Bergen CJ. Osteochondral defects in the ankle: why painful? Knee Surg Sports Traumatol Arthrosc. 2010; 18:570–580.

21. Astrand J, Skripitz R, Skoglund B, Aspenberg P. A rat model for testing pharmacologic treatments of pressure-related bone loss. Clin Orthop Relat Res. 2003; 296–305.

22. Sun SF, Chou YJ, Hsu CW, Chen WL. Hyaluronic acid as a treatment for ankle osteoarthritis. Curr Rev Musculoskelet Med. 2009; 2:78–82.

23. Lussier A, Cividino AA, McFarlane CA, Olszynski WP, Potashner WJ, De Médicis R. Viscosupplementation with hylan for the treatment of osteoarthritis: findings from clinical practice in Canada. J Rheumatol. 1996; 23:1579–1585.

24. 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-A:538–545.

25. Evanich JD, Evanich CJ, Wright MB, Rydlewicz JA. Efficacy of intraarticular hyaluronic acid injections in knee osteoarthritis. Clin Orthop Relat Res. 2001; 173–181.

26. Adams ME, Lussier AJ, Peyron JG. A risk-benefit assessment of injections of hyaluronan and its derivatives in the treatment of osteoarthritis of the knee. Drug Saf. 2000; 23:115–130.

27. Pozo MA, Balazs EA, Belmonte C. Reduction of sensory responses to passive movements of inflamed knee joints by hylan, a hyaluronan derivative. Exp Brain Res. 1997; 116:3–9.