What Is Hyaluronic Acid Injections?
Hyaluronic acid is a natural part of the fluid that lubricates and cushions your joints. In osteoarthritis, the cartilage wears down and the joint fluid becomes thinner and less effective. A hyaluronic acid injection adds a lab-made form of this substance directly into the joint, with the goal of easing pain and improving movement.
Several products are available. Depending on the product, treatment is either a single injection or a series of injections, usually given once a week for three to five weeks. These injections do not rebuild cartilage or reverse arthritis.
Research results are mixed. Some people have meaningful relief that lasts for months, while others notice little change. Your physician will talk with you about what to realistically expect.
Given in our office, with ultrasound or X-ray guidance when needed to place the medicine accurately.
Who Is a Candidate?
You may be a candidate if you have knee osteoarthritis that still hurts despite activity changes, weight management, physical therapy, over-the-counter pain relievers, or cortisone injections. Hyaluronic acid can also be an option if you want to delay joint replacement or if cortisone is not a good fit for you, for example because of diabetes.
For hip arthritis, hyaluronic acid is used off-label, meaning it is not FDA-approved for the hip. Our physicians may discuss it in selected cases. You should not receive an injection if the joint or overlying skin is infected, and you should tell us about allergies to the product's ingredients.
What to Expect
Your physician examines the joint and reviews X-rays, which can be taken in our office. The skin is cleaned and the injection is given into the joint. If the knee is swollen, excess fluid may be drawn off first. Hip injections are deeper and are placed with imaging guidance, such as diagnostic ultrasound or fluoroscopy (live X-ray), both available on site.
Each injection visit is short, and you walk out afterward. If you are getting a series, you return weekly for the remaining injections.
Risks and Side Effects
Hyaluronic acid injections are generally well tolerated. Possible side effects include:
- Pain, swelling, warmth or stiffness in the joint for a few days
- Bruising at the injection site
- An uncommon inflammatory flare in the joint that may need evaluation
- Rare risks such as infection or allergic reaction
Recovery
Avoid strenuous activity, such as running, heavy lifting or long periods on your feet, for about 48 hours after each injection. Normal daily activity is fine. Any relief usually develops over several weeks and, when it helps, can last for several months. The series can often be repeated if it worked well before.
Our on-site physical therapists share your chart with your physician and can build a strengthening program for the muscles around your knee or hip, which helps whatever the injection accomplishes.
Physical therapy happens in our office, with therapists who share your chart. Learn about on-site physical therapy.
Insurance and Cost
Medicare generally covers hyaluronic acid injections for knee osteoarthritis when coverage criteria are met, such as X-ray evidence of arthritis and a trial of other treatments. Commercial plan coverage depends on your plan, and some require prior authorization or a specific product. Hyaluronic acid in the hip is off-label and is usually not covered. Our team verifies your benefits before treatment when you call.
When to Talk to a Specialist
Call our office if knee or hip pain from arthritis limits your walking, sleep or daily activities, or if other treatments are no longer helping.
After an injection, seek urgent care for fever, a hot and very swollen joint, or spreading redness, which can be signs of infection.
