Nonanimal Hyaluronic Acid for the Treatment of Ankle Osteoarthritis: AProspective, Single-Arm Cohort Study

• Published in: The Journal of foot and ankle surgery 2019-05, Vol.58 (3), p.514-518
• Main Authors: Younger, Alastair S.E., Penner, Murray, Wing, Kevin, Veljkovic, Andrea, Nacht, Jeff, Wang, Zhe, Wester, Tawana, Harrison, Andrew
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Ankle Joint - physiopathology; Cohort Studies; disability; Disability Evaluation; Durolane; Female; Humans; Hyaluronic Acid - therapeutic use; Injections, Intra-Articular; intra-articular injection; Male; Middle Aged; Osteoarthritis - drug therapy; Osteoarthritis - physiopathology; pain; viscosupplementation; Viscosupplements - therapeutic use; Visual Analog Scale
• ISSN: 1067-2516; 1542-2224
• DOI: 10.1053/j.jfas.2018.10.003

Ankle osteoarthritis (OA) can cause disabling symptoms, and some patients prefer to be treated with minimally invasive procedures. Nonanimal hyaluronic acid (NASHA) is a cross-linked hyaluronic acid product that has a prolonged intra-articular residence time. The authors report the first study of NASHA for the treatment of ankle OA. Thirty-seven patients with Kellgren-Lawrence grade II or III ankle OA received an intra-articular injection of NASHA (1 mL). Outcomes included visual analogue scale (VAS) scores for pain and disability. At baseline, the mean VAS pain score was 50.1 ± 14.5mm. During the 26-week follow-up period, the least squares (LS) mean change from baseline in the ankle OA VAS pain score was –20.5mm (95% confidence interval [CI] −25.5 to −15.6 mm), an LS mean percentage reduction of 40.0% (95% CI 30.2% to 49.9%). The LS mean change from baseline in the VAS disability score during 26 weeks was −19.2mm (95% CI −24.8 to −13.6 mm), a percentage reduction of 34% (95% CI 22.3% to 45.7%). Five participants experienced a total of 7 adverse events considered to be related to study treatment (injection site pain, n = 3; injection site joint pain, n = 3; plantar fasciitis, n = 1). This study shows promise for viscosupplementation with NASHA in the treatment of ankle OA. A single injection was associated with clinically meaningful reductions in pain and disability during a 26-week period and, in general, was well tolerated.