title: Imaging Guidance Improves the Results of Viscosupplementation with HANOX-M-XL in Patients with Ankle Osteoarthritis: Results of a Clinical Survey in 50 Patients Treated in Daily Practice.
abstract: BACKGROUND
  The objective of this survey was to assess retrospectively the interest of performing viscosupplementation using imaging guidance in patients suffering from ankle osteoarthritis (OA).
  
  
  METHODS
  This is a multicenter retrospective survey using a standardized questionnaire. Fifty patients suffering from ankle OA and treated, in daily clinical practice, with a single intra-articular injection of a novel viscosupplement made of a combination of a non-animal cross-linked hyaluronan and mannitol, HANOX M-XL, were included in the survey. The injection procedure (imaging or landmark guidance), demographic data, patient's self-evaluation of pain, satisfaction, treatment efficacy, and tolerability were collected. Predictive factors of both efficacy and patient's satisfaction were investigated.
  
  
  RESULTS
  The percentages of patients very satisfied/satisfied and not really satisfied/dissatisfied with the treatment were 68% and 32%, respectively. Efficacy was rated as very good, good, moderate, and poor by 38%, 30%, 12%, and 20% of the cases, respectively. Efficacy was unrelated to gender and age and was highly correlated with pain score (P< 0.0001). In satisfied patients, the decrease in consumption of analgesics/non-steroidal anti-inflammatory drugs was >75% in 64% of the cases. Efficacy was significantly different with regard to imaging guidance. There was a statistically significant difference in efficacy and satisfaction between landmark-guided and imaging-guided injections (P= 0.02). The success rate was 2.3 times higher in the imaging-guided group than in the landmark-guided group. No significant difference was found between patients injected under fluoroscopy or ultrasound guidance, despite a trend favoring ultrasound (P= 0.09). Tolerability was rated as very good/good in 47 patients, moderate in two, and poor in one and was unrelated to the type of guidance.
  
  
  CONCLUSIONS
  This preliminary study suggests that the use of imaging guidance significantly optimizes the success rate of ankle viscosupplementation. No safety concern was observed.
  
  
  METHODS
  III.
authors.affiliation: Department of Rheumatology, Hôpital Nord Franche-Comté, Belfort, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Bossert
authors.affiliation: Department of Orthopaedic Surgery, Clinique du Parc, Lyon, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Boublil
authors.affiliation: Department of Sports Medicine, Institut Monégasque de Médecine du Sport, Principauté de Monaco, Monaco.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Parisaux
authors.affiliation: Department of Rheumatology, Hôpital Nord Franche-Comté, Belfort, France.
authors.forename: Ana-Maria
authors.initials: AM
authors.lastname: Bozgan
authors.affiliation: Department of Orthopaedic Surgery, Institut de Chirurgie Orthopédique et Sportive, Marseille, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Richelme
authors.affiliation: Department of Rheumatology, Hôpital Nord Franche-Comté, Belfort, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Conrozier
keywords: ankle; fluoroscopy; guidance; hyaluronic acid; osteoarthritis; ultrasonography; viscosupplementation