Skip to main content

Advertisement

SpringerLink
Log in

Viscosupplementation in the management of ankle osteoarthritis: a review

  • Basic Science
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Osteoarthritis (OA) is a disease of synovial joints and is the most common cause of chronic pain. Viscosupplementation (VS) with hyaluronic acid (HA) is largely used for knee osteoarthritis therapy but the evidence for its usefulness in ankle osteoarthritis is limited. The objective of this review is to assess the efficacy of viscosupplementation treatment of ankle osteoarthritis in the current literature.

Methods

The following databases were searched: Medline (period 2006–2008), Database of Abstract on Reviews and Effectiveness and Cochrane Database of Systematic Reviews. Reference lists of relevant articles were controlled for additional references. The search terms Review, Viscosupplementation (VS), Osteoarthritis (OA), Hyaluronic acid (HA), Hyaluronan, Sodium hyaluronate, Ankle OA, Ankle joint were used to identify all studies relating to the use of VS therapy for the ankle OA. Methodological quality of included studies was assessed by assigning level of evidence as previously defined by the Centre for Evidence Based Medicine (CEBM).

Result

Seven articles concerning the efficacy of a total of 275 patients undergoing VS treatment for ankle OA were included. One European study, one Taiwanese study, one Italian study, one Turkish study and three American studies with level of evidence ranging from I to IV evaluated the following products: Hyalgan®, Synvisc®, Supartz®, Adant®.

Conclusion

Viscosupplementation is used widely in knee OA and is included in the professional guidelines for treatment of the disease in this joint. The potential for treating osteoarthritis of the ankle joint by viscosupplementation has been suggested in the literature, however, no dosing studies have been published to date, and dosing in the ankle joint remains an area for discussion. Viscosupplementation could potentially provide an useful alternative in treating such patients with painful ankle OA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

AAA:

Arthroscopy

AA + H:

Arthroscopy + Hylan GF-20

AEs:

Adverse events

AOFAS:

American Orthopaedic Foot and Ankle Society

AOS:

Ankle Osteoarthritis Score

CEBM:

Centre for Evidence Based Medicine

FDA:

Food and Drug Administration

HA:

Hyaluronic acid

HYL:

Sodium hyaluronate

kDa:

Kilodalton

IA:

Intra-articular

ITT:

Intention to treat

MW:

Molecular weight

NSAID:

Non-steroidal antiinflammatory drug

OA:

Osteoarthritis

RCTs:

Randomised controlled trials

ROM:

Range of motion

VAS:

Visual analogue scale

VS:

Viscosupplementation

WOMAC:

Western Ontario and McMaster Universities

References

  1. Felson DT, Lawrence RC, Dieppe PA, Hirsch R, Helmick CG, Jordan JM, Kington RS, Lane NE, Nevitt MC, Zhang Y, Sowers M, McAlindon T, Spector TD, Poole AR, Yanovski SZ, Ateshian G, Sharma L, Buckwalter JA, Brandt KD, Fries JF (2000) Osteoarthritis: new insights. Part 1: the disease and its risk factors. Ann Intern Med 133(8):635–646 (Review)

    CAS  PubMed  Google Scholar 

  2. Buckwalter JA, Mankin HJ (1998) Articular cartilage: degeneration and osteoarthritis, repair, regeneration, and transplantation. Instr Course Lect 47:487–504 (Review)

    CAS  PubMed  Google Scholar 

  3. Ea Balazs (1982) The physical properties of synovial fluid and the special role of hyaluronic acid. Disorders of the knee. T.B. Lippincott, Philadelphia

    Google Scholar 

  4. Balazs EA, Denlinger JL (1985) Sodium hyaluronate acid and joint function. J Equine Vet Sci 5:217–218

    Article  Google Scholar 

  5. Altman D (1992) Laboratory findings in osteoarthritis. In: Moskowtz R, Howell D, Goldberg V, Mankin J (eds) Osteoarthritis-diagnosis and medical surgical management. WB Saunders, Philadelphia

    Google Scholar 

  6. Balazs EA, Wason D, Huff IF, Roseman S (1967) Hyaluronic acid in synovial fluid: molecular parameters of hyaluronic acid in normal and arthritic fluids. Arthritis Rheum 10:357–376

    Article  CAS  PubMed  Google Scholar 

  7. Balazs EA, Briller S, Denlinger J (1981) Na-hyaluronate molecular size variations in equine arthritis and human arthritic synovial fluid and the effect on phagocytic cells. In: Talbot J (ed) Seminars in arthritis and rheumatism. Grune & Stratton, New York

    Google Scholar 

  8. Dahl LB, Dahl IM, Enstron-Laurent A, Granath K (1985) Concentration and molecular weight of sodium hyaluronate in synovial fluid from patients with rheumatoid arthritis and other arthropathies. Ann Rheum Dis 44:817–822

    Article  CAS  PubMed  Google Scholar 

  9. Larsen NE, Lombard KM, Parent EG, Balazs EA (1992) Effect of hylan on cartilage and chondrocyte cultures. J Orthop Res 10:23–32

    Article  CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  11. Ghosh P, Guidolin D (2002) Potential mechanism of action of intra-articular hyaluronan therapy in osteoarthritis: are the effects molecular weight dependent? Semin Arthritis Rheum 32(1):10–37

    Article  CAS  PubMed  Google Scholar 

  12. Balazs EA, Denlinger JL (1984) The synovial cell. In: Scarpelli DG, Migaki G, Alan R (eds) Comparative pathobiology of mayor age-related disease: current status and research frontiers (Modern aging research 4). Liss Inc., New York

    Google Scholar 

  13. Buckwalter JA, Saltzman C, Brown T (2004) The impact of osteoarthritis: implications for research. Clin Orthop Relat Res 427(Suppl):S6–S15 Review

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  16. Brown TD, Johnston RC, Saltzman CL, Marsh JL, Buckwalter JA (2006) Posttraumatic osteoarthritis: a first estimate of incidence, prevalence, and burden of disease. J Orthop Trauma 20(10):739–744

    Article  PubMed  Google Scholar 

  17. Horisberger M, Valderrabano V, Hintermann B (2009) Posttraumatic ankle osteoarthritis after ankle-related fractures. J Orthop Trauma 23(1):60–67

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  19. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines (2000) Recommendations for the medical management of osteoarthritis of the hip and the knee: 2000 update. Arthritis Rheum 43:1905–1915

    Article  Google Scholar 

  20. Pendleton A, Arden N, Dougados M, Doherty M, Bannwarth B, Bijlsma JW et al (2000) EULAR recommendations for the management of knee osteoarthritis: report of a task force of the Standing Committee for International Clinical Studies including Therapeutic Trials (ESCISIT). Ann Rheum Dis 59:936–944

    Article  CAS  PubMed  Google Scholar 

  21. Pleimann JH, Davis WH, Cohen BE et al (2002) Viscosupplementation for the arthritic ankle. Foot Ankle Clin 7(3):489–494

    Article  PubMed  Google Scholar 

  22. Wang CW, Gao LH, Jin XY et al (2002) Clinical study of sodium hyaluronate in supplementary treatment of comminuted fracture of ankle. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 16(1):21–22

    PubMed  Google Scholar 

  23. Gaston MS, Tiemessen CH, Philips JE (2007) Intra-articular hip viscosupplementation with synthetic hyaluronic acid for osteoarthritis: efficacy, safety and relation to pre-injection radiographs. Arch Orthop Trauma Surg 127(10):899–903

    Article  CAS  PubMed  Google Scholar 

  24. Migliore A, Tormenta S, Martin LSM et al (2005) Open pilot study of ultrasound-guided intra-articular injection of hylan G-F 20 (Synvisc) in the treatment of symptomatic hip osteoarthritis. Clin Rheumatol 24:285–289

    Article  PubMed  Google Scholar 

  25. Tikiz C, Unlu Z, Sener A et al (2005) Comparison of efficacy of lower and higher molecular weight viscosupplementation in the treatment of hip osteoarthritis. Clin Rheumatol 24:244–250

    Article  PubMed  Google Scholar 

  26. Migliore A, Martin LS, Alimonti A, Valente C, Tormenta S (2003) Efficacy and safety of viscosupplementation by ultrasound-guided intra-articular injection in osteoarthritis of the hip. Osteoarthritis Cartilage 11:305–306

    Article  CAS  PubMed  Google Scholar 

  27. Migliore A, Tormenta S, Massafra U, Bizzi E, Iannessi F, Alimonti A, Granata M (2008) Intra-articular administration of hylan G-F 20 in patients with symptomatic hip osteoarthritis: tolerability and effectiveness in a large cohort study in clinical practice. Curr Med Res Opin 24(5):1309–1316

    Article  CAS  PubMed  Google Scholar 

  28. Migliore A, Tormenta S, Massafra U, Carloni E, Padalino C, Iannessi F, Alimonti A, Martin LS, Granata M (2005) Repeated ultrasound-guided intra-articular injections of 40 mg of Hyalgan may be useful in symptomatic relief of hip osteoarthritis. Osteoarthritis Cartilage 13:1126–1127

    Article  CAS  PubMed  Google Scholar 

  29. Migliore A, Tormenta S, Martin LS, Iannessi F, Massafra U, Carloni E, Monno D, Alimonti A, Granata M (2006) The symptomatic effects of intra-articular administration of hylan G-F 20 on osteoarthritis of the hip: clinical data of 6 months follow-up. Clin.Rheumatol 25:389–393

    Article  PubMed  Google Scholar 

  30. Migliore A, Tormenta S, Massafra U, Martin Martin LS, Carloni E, Padalino C, Alimonti A, Granata M (2006) 18-month observational study on efficacy of intraarticular hyaluronic acid (Hylan G-F 20) injections under ultrasound guidance in hip osteoarthritis. Reumatismo 58:39–49

    PubMed  Google Scholar 

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

    Article  Google Scholar 

  32. Marshall KW (2003) Intra-articular hyaluronan therapy. Foot Ankle Clin 8:221–232

    Article  PubMed  Google Scholar 

  33. Clarke S, Lock V, Duddy J et al (2005) Intra-articular hylan G-F 20 in the management of patellofemoral osteoarthritis of the knee. Knee 12:57–62

    Article  PubMed  Google Scholar 

  34. Roux C, Fontas E, Breuil V et al (2007) Injection of intra-articular sodium hyaluronidate (sinovial) into the carpometacarpal joint of the thumb (CMC1) in osteoarthritis. A prospective evaluation of efficacy. Joint Bone Spine 74(4):368–372

    Article  CAS  PubMed  Google Scholar 

  35. Pelletier JP, Martel-Pelletier J (1993) The pathophysiology of osteoarthritis and the implication of the use of hyaluronan and hylan as therapeutic agents in viscosupplementation. J Rheumatol Suppl 39:19–24

    CAS  PubMed  Google Scholar 

  36. Weiss C, Band P (1995) Musculoskeletal applications of hyaluronan and hylan. Potential uses in the foot and ankle. Clin Podiatr Med Surg 12:497–517

    CAS  PubMed  Google Scholar 

  37. Witteveen A, Giannini S, Guido G, Jerosch J, Lohrer H, Vannini F, Donati F, Schulz A, Scholl J, Sierevelt I, van Dijk N (2008) 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 14:145–152

    Article  PubMed  Google Scholar 

  38. Sun SF, Chou YJ, Hsu CW, Hwang CW, Hsu PT, Wang JL, Hsu YW, Chou MC (2006) Efficacy of intra-articoular hyaluronic acid in patients with osteoarthritis of the ankle: a prospective study. Osteoarthritis Cartilage 14:867–874

    Article  PubMed  Google Scholar 

  39. Salk RS, Chang TJ, D’Costa WF, Soomekh DJ, Grogan KA (2006) Sodium hyaluronate in the treatment of osteoarthritis of the ankle: a controlled, randomized, double-blind pilot study. J Bone Joint Surg Am 88(2):295–302

    Article  PubMed  Google Scholar 

  40. Cohen MM, Altman RD, Hollstrom R, Hollstrom C, Sun C, Gipson B (2008) Safety and efficacy of intra-articular sodium hyaluronate (Hyalgan) in a randomized, double-blind study for osteoarthritis of the ankle. Foot Ankle Int 29(7):657–663

    Article  PubMed  Google Scholar 

  41. Karatosun V, Unver B, Ozden A, Ozay Z, Gunal I (2008) Intra-aticular hyaluronic acid compared to exercise therapy in osteoarthritis of the ankle. A prospective randomized trial with long-term follow-up. Clin Exp Rheumatol 26:288–294

    CAS  PubMed  Google Scholar 

  42. Carpenter B, Motley T (2008) The role of viscosupplementation in the ankle using Hylan GF-20. J Foot Ankle Surg 47(5):377–384

    Article  PubMed  Google Scholar 

  43. Luciani L, Cadossi M, Tesei F, Chiariello E, Giannini S (2008) Viscosupplementation for grade II osteoarthritis af the ankle: prospective study at 18 months’ follow-up. Chir Organi Mov 92(3):155–160

    Article  PubMed  Google Scholar 

  44. Domsic RT, Saltzman CL (1998) Ankle osteoarthritis scale. Foot Ankle Int 19(7):466–471

    CAS  PubMed  Google Scholar 

  45. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M (1994) Clinical rating systems for the ankle–hind-foot, midfoot, hallux and lesser toes. Foot Ankle Int 15:349–353

    CAS  PubMed  Google Scholar 

  46. Adams ME, Lussier AJ, Peyron JG (2000) A risk-benefit assessment of injections of hyaluronan and its derivate in the treatment of osteoarthritis of the knee. Drug Saf 2:115–130

    Article  Google Scholar 

  47. Blaine T, Moskowitz R, Udell J, Skyhar M, Levin R, Friedlander J, Daley M, Altman R (2008) Treatment of persistent shoulder pain with sodium hyaluronate: a randomized, controlled trial. A multicenter study. J Bone Joint Surg Am 90(5):9–979

    Article  Google Scholar 

  48. Silverstein E, Leger R, Shea KP (2007) The use of inta-articular Hylan GF-20 in the treatment of symptomatic osteoarthritis of the shoulder: a preliminary study. Am J Sports Med 35(6):979–985

    Article  PubMed  Google Scholar 

  49. Figen Ayhan F, Ustün N (2009) The evaluation of efficacy and tolerability of Hylan GF-20 in bilateral thumb base osteoarthritis: 6 months follow-up. Clin Rheumatol 28(5):535–541

    Article  CAS  PubMed  Google Scholar 

  50. Moran SL, Duymaz A, Karabekmez FE (2009) The efficacy of hyaluronic acid in the treatment of osteoarthritis of the trapeziometacarpal joint. J Hand Surg Am 34(5):942–944

    Article  PubMed  Google Scholar 

  51. Salini V, De Amicis D, Abate M, Natale MA, Di Iorio A (2009) Ultrasound-guided hyaluronic acid injection in carpometacarpal osteoarthritis: short-term results. Int J Immunopathol Pharmacol 22(2):455–460

    CAS  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Rheumatology, S.Pietro FBF Hospital, via Cassia 600, 00189, Rome, Italy

    Alberto Migliore, Francesca Giovannangeli, Emanuele Bizzi, Umberto Massafra & Andrea Alimonti

  2. Rheumatology, 2nd Medical School, Sapienza University, Rome, Italy

    Bruno Laganà, Andrea Diamanti Picchianti & Valentina Germano

  3. Rheumatology and OP Center, San Filippo Neri Hospital, Rome, Italy

    Mauro Granata

  4. ISBEM Research Center, Brindisi, Italy

    Prisco Piscitelli

Authors
  1. Alberto Migliore
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francesca Giovannangeli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Emanuele Bizzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Umberto Massafra
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andrea Alimonti
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bruno Laganà
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Andrea Diamanti Picchianti
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Valentina Germano
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Mauro Granata
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Prisco Piscitelli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Francesca Giovannangeli.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Migliore, A., Giovannangeli, F., Bizzi, E. et al. Viscosupplementation in the management of ankle osteoarthritis: a review. Arch Orthop Trauma Surg 131, 139–147 (2011). https://doi.org/10.1007/s00402-010-1165-5

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-010-1165-5

Keywords

Search

Navigation