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Effectiveness of Intra-Articular Hyaluronic Acid for Ankle Osteoarthritis Treatment: A Systematic Review and Meta-Analysis

  • Ke-Vin Chang
    Affiliations
    Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, BeiHu Branch and National Taiwan University College of Medicine, Taipei

    Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei
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  • Ming-Yen Hsiao
    Affiliations
    Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
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  • Wen-Shiang Chen
    Affiliations
    Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
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  • Tyng-Guey Wang
    Affiliations
    Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
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  • Kuo-Liong Chien
    Correspondence
    Corresponding author: Kuo-Liong Chien, MD, PhD, Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
    Affiliations
    Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei

    Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Published:November 12, 2012DOI:https://doi.org/10.1016/j.apmr.2012.10.030

      Abstract

      Objectives

      To explore the effectiveness and safety of hyaluronic acid (HA) administration for ankle osteoarthritis (OA), and to investigate the effects of variations in HA regimens on treatment responses.

      Data Sources

      Electronic databases, including PubMed and Scopus, were searched from January 1995 to June 2012.

      Study Selection

      We included randomized controlled trials (RCTs) or prospective cohort studies that employed intra-articular HA to treat ankle OA. Four RCTs, 1 comparative study, and 4 single-arm prospective studies were identified, comprising 354 participants.

      Data Extraction

      We determined effect sizes for selected studies by extracting pain scores from ankle OA or visual analog scales before and after HA or reference treatments. Meta-regression was implemented to determine whether outcomes were modified by variations in HA regimens.

      Data Synthesis

      The pooled effect size of improvement scores from baseline was 2.01 (95% confidence interval [CI], 1.27–2.75), whereas the values of comparisons with reference treatments including saline, exercise, and arthroscopy reduced to 0.85 (95% CI, −0.13 to 1.83). The placebo effect of the injection procedure accounted for 87% of the observed efficacy of HA treatment. The meta-regression indicated that the molecular weight was not associated with the magnitude of pain relief, but increases in total doses and active ingredients administered might result in a better outcome. Conversely, increases in injection volumes might cause a reduction of effect sizes. Regarding the side effects, the use of extremely high molecular weight HA frequently caused early postinjection pain.

      Conclusions

      Intra-articular HA administration can significantly reduce pain in ankle OA compared with the condition before treatment, and it is likely superior to reference therapy. We recommend using multiple doses with an appropriate injection volume to achieve maximum effectiveness.

      Keywords

      List of abbreviations:

      CI (confidence interval), HA (hyaluronic acid), MW (molecular weight), OA (osteoarthritis)
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