The optimal injection technique for the osteoarthritic ankle: A randomized, cross-over trial

Background: To optimize the injection technique for the osteoarthritic ankle in order to enhance the effect of intra-articular injections and minimize adverse events. Methods: Randomized cross-over trial. Comparing two injection techniques in patients with symptomatic ankle osteoarthritis. Patients received an injection with hyaluronic acid using either one of the techniques. Four weeks later the second injection was given using the other technique. Primary outcome was the failure rate of the injection. Results: Seventy patients fulfilled the study. The failure rate for both injection techniques was 24%. Forty-one patients in the traction group and thirty-nine in the group without traction experienced treatment related local adverse events. Other secondary outcomes did not show any difference between injection techniques. Conclusions: There is no significant difference comparing the two injection methods regarding any of our formulated outcome measures. The use of contrast aided fluoroscopy for injecting the severe osteoarthritic ankle can be advised at all times. (C) 2013 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved