title: Effectiveness of intra-articular hyaluronan (Synvisc, hylan G-F 20) for the treatment of first metatarsophalangeal joint osteoarthritis: a randomised placebo-controlled trial.
abstract: OBJECTIVE
  To evaluate the effectiveness of a single intra-articular injection of hylan G-F 20 (Synvisc) for symptomatic first metatarsophalangeal joint (MTPJ) osteoarthritis (OA).
  
  
  METHODS
  Participants (n = 151) with symptomatic first MTPJ OA were randomly allocated to receive up to 1 ml intra-articular injection of either hylan G-F 20 or placebo (saline). Participants and assessors were blinded. Outcomes were evaluated at 1, 3 and 6 months after injection. The primary outcome measurement was the foot pain domain of the Foot Health Status Questionnaire (FHSQ) at 3 months. Secondary outcome measurements were foot function assessed via the FHSQ, first MTPJ pain and stiffness, magnitude of symptom change, global satisfaction, health-related quality of life (assessed using the Short-Form-36 version two), first MTPJ dorsiflexion range of motion, hallux plantar flexion strength, use of pain-relieving medication or co-interventions and changes in plantar pressures.
  
  
  RESULTS
  No statistically significant differences in foot pain were found between the groups at 3 months. There were few statistically significant differences in the secondary outcome measures. Overall, the incidence of adverse effects was not significantly different between groups.
  
  
  CONCLUSIONS
  An intra-articular injection of hylan G-F 20 is no more effective than a placebo in reducing symptoms in people with symptomatic first MTPJ OA.Australian New Zealand Clinical Trials Registry: number ACTRN12607000654459.
authors.affiliation: Musculoskeletal Research Centre, Faculty of Health Sciences, La Trobe University, Melbourne, Australia. s.munteanu@latrobe.edu.au
authors.forename: Shannon E
authors.initials: SE
authors.lastname: Munteanu
authors.forename: Gerard V
authors.initials: GV
authors.lastname: Zammit
authors.forename: Hylton B
authors.initials: HB
authors.lastname: Menz
authors.forename: Karl B
authors.initials: KB
authors.lastname: Landorf
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Handley
authors.forename: Ayman
authors.initials: A
authors.lastname: Elzarka
authors.forename: Jason
authors.initials: J
authors.lastname: Deluca
mesh_terms: D000328:Adult; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D007270:Injections, Intra-Articular; D008297:Male; D008683:Metatarsophalangeal Joint / Q000503:physiopathology*; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D010146:Pain / Q000209:etiology; D016059:Range of Motion, Articular; D016896:Treatment Outcome; D055676:Viscosupplementation / Q000379:methods; D055675:Viscosupplements / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D055675:Viscosupplements; C049816:hylan; D006820:Hyaluronic Acid