Hyaluronic acid injections can be recommended to people with ankle OA if they have an inadequate response to simple analgesics, a Cochrane review of the evidence concludes.

The review of clinical trials investigating any non-surgical intervention for ankle OA proved inconclusive as to whether there was a benefit or harm for HA as treatment for ankle OA compared to placebo at six months, the musculoskeletal group said.

Evidence comparing HA to other treatments was also inconclusive, they said.

Since the aetiology of ankle OA is different, guidelines that are currently used for hip and knee OA may not be applicable for ankle OA, the authors noted.

Simple analgesics as recommended for hip and knee OA seemed a reasonable first step to treat ankle OA, they said.

But if patients had an inadequate response top painkillers HA injections could be “conditionally recommended” the group based in The Netherlands said.

It was unclear which patients (age, grade of ankle OA) benefit the most from HA injections and which dosage schedule should be used, they added.

The Cochrane review echoes recently noted confusion around the use of viscosupplementation in knee osteoarthritis.

As reported by the limbic in August, rheumatologist Roy Altman from the University of California in Los Angeles lamented the lack of consensus within international IA-HA treatment recommendations.

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