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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

 

Re: Hyalgan for Ankles

Hi Steve,

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?:wacko:). 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."

Lee

 

Hi Lee:

So OK results???

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

 

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.

Lee

 

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 and Ankle Surgery Volume 14, Issue 3, 2008, Pages 145-152

 

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.

while reviewing few patients tells that pain is reduced for short term.
most of them have no effect even after 4 doses. http://www.podiatry-arena.com/images/smilies/bang.gif
:bang:

we have rarely come across ankle OA , most of them post traumatic,
Is it primary OA of ankle common ?

suresh

 

, we are giving regularly in your institution, as 2cc intra articular knee,

sorry in our institution,

suresh

 

The Role of Viscosupplementation in the Ankle Using Hylan G-F 20
Brian Carpenter, Travis Motley
Journal of Foot and Ankle Surgery Volume 47, Issue 5, Pages 377-384 (September 2008)

 

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.