Woo Inha, Park Jeong-Jin, Park Chul Hyun
The Armed Forces Daejeon Hospital, Daejeon, Republic of Korea.
Korea Armed Forces Athletic Corps, Mungyeong, Gyeongsangbuk-do Province, Republic of Korea.
BMC Musculoskelet Disord. 2025 Mar 11;26(1):239. doi: 10.1186/s12891-025-08488-0.
Intra-articular corticosteroid injection is commonly used for pain relief in ankle osteoarthritis (OA). The effects of corticosteroids (CS) are short-lived, whereas hyaluronic acid (HA) have longer-lasting effects. The objective was to compare the efficacy of dual injections of CS and HA to CS alone. We hypothesized that intra-articular injections of dual agents would be more effective than CS alone.
A single-blind, randomized, controlled trial was designed to investigate this hypothesis. 135 patients with ankle OA were enrolled into an intra-articular CS injection group (CS group, n = 61) or dual HA plus CS injection group (CS + HA group, n = 74). The CS group received 1 mL of corticosteroid and 1 mL of 0.5% bupivacaine and 1 mL of normal saline once, and the CS + HA group received 3 mL of a total of 5 mL mixtures containing 2 mL of HA, or 1 mL of corticosteroid, 0.5% bupivacaine, and normal saline in the first week, followed by 2 mL of HA in the second and third weeks. Clinical evaluations were performed before injection, 6 and 12 weeks after the first injections. The Ankle Osteoarthritis Scale (AOS) was used as the primary outcome measure, and the Visual Analogue Scale (VAS), Short Form Health Survey (SF-36), and complications were used as secondary outcomes.
The mean AOS change from baseline was significantly greater in the CS + HA group than in the CS group at 6 (p ≤ 0.01) and 12 weeks (p ≤ 0.01). The mean VAS change from baseline was significantly greater in the CS group than in the CS + HA group at 6 weeks (p = 0.023), but not at 12 weeks (p = 0.731). The mean SF-36 change from baseline was not significant between the CS and CS + HA groups at 6 (p = 0.416) and 12 weeks (p = 0.215).
The combination of corticosteroid and HA injection is more effective than corticosteroid alone in relieving pain in ankle OA.
Clinical Research Information Service in South Korea, KCT0008690 // Registration Date (First Posted): July 21th, 2023 ( http://cris.nih.go.kr ).
关节内注射皮质类固醇常用于缓解踝关节骨关节炎（OA）的疼痛。皮质类固醇（CS）的效果是短暂的，而透明质酸（HA）的效果持续时间更长。目的是比较CS和HA联合注射与单独注射CS的疗效。我们假设关节内注射两种药物比单独注射CS更有效。
设计了一项单盲、随机、对照试验来研究这一假设。135例踝关节OA患者被纳入关节内CS注射组（CS组，n = 61）或HA加CS联合注射组（CS + HA组，n = 74）。CS组接受1 mL皮质类固醇、1 mL 0.5%布比卡因和1 mL生理盐水注射一次，CS + HA组在第一周接受总共5 mL混合物中的3 mL，其中含有2 mL HA，或1 mL皮质类固醇、0.5%布比卡因和生理盐水，在第二周和第三周接受2 mL HA。在注射前、首次注射后6周和12周进行临床评估。踝关节骨关节炎量表（AOS）用作主要结局指标，视觉模拟量表（VAS）、简短健康调查问卷（SF - 36）和并发症用作次要结局。
在6周（p≤0.01）和12周（p≤0.01）时，CS + HA组从基线开始的平均AOS变化显著大于CS组。在6周时，CS组从基线开始的平均VAS变化显著大于CS + HA组（p = 0.023），但在12周时无显著差异（p = 0.731）。在6周（p = 0.416）和12周（p = 0.215）时，CS组和CS + HA组从基线开始的平均SF - 36变化无显著差异。
皮质类固醇和HA联合注射在缓解踝关节OA疼痛方面比单独使用皮质类固醇更有效。
韩国临床研究信息服务中心，KCT0008690 // 注册日期（首次发布）：2023年7月21日（http://cris.nih.go.kr）
