Study: No meaningful benefit from hyaluronic acid injections for elbow arthritis

Viscosupplementation provided only slight, short-term pain relief and a limited effect on activity impairment.

Hyaluronic acid injections appear to provide only limited, short-term improvements in pain and function for patients with post-traumatic elbow osteoarthritis, a retrospective study suggests.

"[The] use of viscosupplementation ... provides only slight, short-term pain relief and a very limited decrease in activity impairment," the study authors said, noting they found no significant effect for two of three pain and function assessments.

"Therefore, in our opinion, viscosupplementation is not suitable for the treatment of post-traumatic osteoarthritis of the elbow," they said.

Richard W. van Brakel, MD, and Denise Eygendaal, PhD, of the Amphia Hospital in Breda, The Netherlands, reviewed prospectively collected data for 19 elbows in 18 patients. The study group included 10 men and eight women treated at an average age of 45.6 years. All patients had clinically symptomatic mild to moderate elbow osteoarthritis confirmed radiographically, according to the study, published in the journal Arthroscopy.

All patients received three injections of 2 mL sodium hyaluronate (Fermathron, Fermentech Medical) with a concentration of 20 mg/2 mL. Injections were performed at regular intervals within 4 weeks, the authors said.

All elbows had a stable medial collateral ligament and an intact ulnar nerve. All elbows also had negative pivot shift test results, they noted.

At 3-months follow-up, patients showed a slight, significant mean improvement of 1.47 points in Elbow Function Assessment Score. However, no other parameters were affected, according to the study.

Researchers also saw a similar small improvement of 4.1 points after 3 months in the Functional Rating Index of Broberg and Morrey, produced by a slight but statistically significant pain improvement. However, no clinically relevant improvement was noted at 6-months follow-up, and range of motion, instability and strength all remained unaffected, the authors said.

The Modified Andrews Elbow Scoring System did show a small, significant decrease in pain as well as a slight improvement in activity impairment score at 3 months. Also, "Unlike the two previously mentioned scoring systems, the total score retained the statistically significant improvement of 2.8125 points after 6 months (P=.023)," the authors said.

Despite some benefit, "Two of the three rating systems showed no long-term beneficial effect with the medication, and therefore viscosupplementation is not suitable for patients who have a slight offset after post-traumatic arthritis of the elbow," they said.

For more information:
Brakel RW, Eygendaal D. Intra-articular injection of hyaluronic acid is not effective for the treatment of post-traumatic osteoarthritis of the elbow. Arthroscopy. 2006;22:1199-1203.