The Journal of Bone and Joint Surgery (American). 2006;88:295-302.
doi:10.2106/JBJS.E.00193
© 2006 The Journal of Bone and Joint Surgery, Inc.
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow CME: Take the activity for this article:
 CME 1: January, February, March 2006
Right arrow [Supplementary Material]
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow Rights and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Salk, R. S.
Right arrow Articles by Grogan, K. A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Salk, R. S.
Right arrow Articles by Grogan, K. A.
Related Collections
Right arrow Foot/Ankle
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Facebook   Add to Technorati   Add to Twitter  
What's this?

Sodium Hyaluronate in the Treatment of Osteoarthritis of the Ankle: A Controlled, Randomized, Double-Blind Pilot Study

Robert S. Salk, DPM1, Thomas J. Chang, DPM1, Walter F. D'Costa, DPM2, David J. Soomekh, DPM3 and Kirk A. Grogan, DPM1

1 45 Castro Street, Suite #315, San Francisco, CA 94114. E-mail address for R. Salk: drsalk{at}yahoo.com. E-mail address for T. Chang: changgang5{at}aol.com. E-mail address for K. Grogan: kagrogan{at}yahoo.com
2 2281 Cleveland Avenue, Santa Rosa, CA 95403. E-mail address: noshib{at}aol.com
3 2121 Wilshire Boulevard, Suite #101, Santa Monica, CA 90403. E-mail address: dsoomekh{at}hotmail.com

Investigation performed at the Northern California Foot and Ankle Center, San Francisco and Santa Rosa, California

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

Note: The authors thank Sara Dahle, MPH, and Huong Le, MPH, for their assistance in statistical analysis.

In support of their research for or preparation of this manuscript, one or more of the authors received grants or outside funding from Sanofi-Aventis, Inc. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Intra-articular injections of hyaluronans have been shown to be safe and effective for the treatment of pain associated with osteoarthritis of the knee. This pilot study was undertaken to gather preliminary data on the efficacy and safety of five weekly intra-articular injections of Hyalgan (sodium hyaluronate; molecular weight, 500 to 730 kDa) as compared with saline solution for the treatment of pain associated with osteoarthritis of the ankle.

Methods: Twenty patients at two test sites were randomized with use of a double-blind (blinded observer), saline solution-controlled, parallel experimental design. Patients were randomized to receive five weekly intra-articular injections of either 1 mL of sodium hyaluronate (10 mg/mL) or 1 mL of phosphate-buffered saline solution into the ankle joint. The primary outcome measurement was the ankle osteoarthritis score. Several secondary outcome measures also were assessed.

Results: Significant improvement in the mean ankle osteoarthritis score from baseline was seen at all follow-up visits from one to six months in both the sodium hyaluronate group and the saline solution group (p < 0.0001). In addition, five of nine patients in the sodium hyaluronate group had >30 mm of improvement in this score, compared with one of eight patients in the control group. No withdrawals were directly attributable to the injections of sodium hyaluronate or saline solution, and no severe medication-related adverse events were observed.

Conclusions: The present study suggests that five weekly intra-articular injections of sodium hyaluronate (molecular weight, 500 to 730 kDa) are well tolerated, can provide sustained relief of pain, and can improve function in patients with osteoarthritis of the ankle. These findings are consistent with those of previously published studies involving intra-articular injections of sodium hyaluronate in other joints, but they require confirmation in a large, randomized, saline solution-controlled study.

Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Facebook Facebook   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 Am J Sports MedHome page
P. F. O'Loughlin, B. E. Heyworth, and J. G. Kennedy
Current Concepts in the Diagnosis and Treatment of Osteochondral Lesions of the Ankle
Am. J. Sports Med., February 1, 2010; 38(2): 392 - 404.
[Abstract] [Full Text] [PDF]

Home page
 Am J Sports MedHome page
E. J. Strauss, J. A. Hart, M. D. Miller, R. D. Altman, and J. E. Rosen
Hyaluronic Acid Viscosupplementation and Osteoarthritis: Current Uses and Future Directions
Am. J. Sports Med., August 1, 2009; 37(8): 1636 - 1644.
[Abstract] [Full Text] [PDF]

Home page
 J Am Acad Orthop SurgHome page
E. V. Cheung, R. Adams, and B. F. Morrey
Primary Osteoarthritis of the Elbow: Current Treatment Options
J. Am. Acad. Ortho. Surg., February 1, 2008; 16(2): 77 - 87.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
O. A. Alade and M. S. Mizel
What's New in Foot and Ankle Surgery
J. Bone Joint Surg. Am., April 1, 2007; 89(4): 914 - 921.
[Full Text] [PDF]