Commentary & Perspective A Firmer Base for Clinical Judgment About Hyaluronic Acid Injection Commentary on an article by Henry DeGroot III, MD, et al.: ‘‘Intra-Articular Injection of Hyaluronic Acid Is Not Superior to Saline Solution Injection for Ankle A

For most patients, the natural history of osteoarthritis of a lower extremity joint is one of insidious onset and gradual deterioration. The symptoms wax and wane over time, with the frequency of the painful episodes gradually increasing in both intensity and duration. It takes time and personal reflection for patients to decide that a surgical opinion is necessary. The primary role of the treating surgeon is not only to identify the best mode of treatment but also to discuss the limitations of the proposed interventions. Withmany surgical options, the recovery time can be substantial and the outcomes variable. The entire process can take years by the time the patient decides to proceed with surgery. During the interval between the onset of symptoms and surgical intervention, many patients seek effective and affordable treatments tomanage their worsening condition. Patients often ask if there is away to rejuvenate or grow the cartilage that has been lost in the joint. The option of injecting a lubricant into the joint makes sense to the patient and is often embraced with enthusiasm. At this point, they are relying on their treating physician to consider all aspects of the proposed intervention, including the risks, benefits, reliability, cost, effectiveness, and duration of the pain relief. It has been our experience that it does not take much time or effort to convince a patient to agree with the option of having his or her arthritic ankle joint injected with a hyaluronic acid-containing solution. Unfortunately, many physicians themselves have not required much convincing either. Studies supporting the safety and effectiveness of hyaluronic acid-containing injections for the treatment of knee arthritis along with favorable results from many of the initial investigations of its utility for treating ankle osteoarthritis have been met with optimistic enthusiasm by our profession. T