Hyaluronic Acid Injections for Arthritic Joints
Hyaluronic acid injection, also known as viscosupplementation, is a pain-relieving treatment for osteoarthritis, and is most often used where the joint changes are mild to moderate. It can be used in almost any arthritic joint. The knee is the most common, but the same treatment is used in the shoulder, hip, ankle, the small joints of the hand and thumb, and the big toe.
What is hyaluronic acid?
Hyaluronic acid is a naturally occurring substance found in the synovial fluid of your joints, where it acts as a lubricant and a cushion. In a joint affected by osteoarthritis those natural levels are depleted, and an injection supplements them.
Why have a hyaluronic acid injection?
The aim is to lubricate and cushion the joint, reducing pain, improving how the joint moves, and potentially delaying the need for more invasive treatment such as surgery. It is an option where joint pain persists despite rehabilitation and simple pain relief.
Which joints can be treated?
Almost any osteoarthritic joint can be considered. In practice the most common are:
- Knee osteoarthritis, the most frequently treated joint
- Shoulder osteoarthritis
- Hip osteoarthritis
- Ankle osteoarthritis
- The small joints of the hand, including the base of the thumb
- The big toe
Which hyaluronic acid do you use?
We use Durolane, Synvisc One and Biolevox. Durolane is the one we use most often. Which product suits you is decided at your appointment, once the joint has been scanned and assessed, and depends on the joint being treated, the state of the joint and how you responded to any previous injections.
How long does a hyaluronic acid injection last?
This depends on the product. Durolane (Bioventus) is a single injection that works for up to 26 weeks. Some other hyaluronic acid preparations are given as a course of injections over a few weeks rather than as one.
Other options for an arthritic knee
Two related treatments may also be considered. Cingal combines hyaluronic acid with a steroid in a single injection, so it can settle inflammation quickly as well as lubricating the joint. Arthrosamid is not a hyaluronic acid at all but a hydrogel, given as one injection and intended to last considerably longer.
How is the injection done?
The injection is given in clinic as an outpatient procedure, and hyaluronic acid is injected directly into the joint through a fine needle.
Like all injections at Meyer Physio, it is placed under live ultrasound guidance, so the medication reaches the joint space itself rather than the tissue around it. That makes the injection more accurate and more comfortable than one placed by feel, and in small joints such as the thumb or the big toe it is what makes an accurate injection realistic at all.
How effective is it?
Results vary between individuals. Some people get significant pain relief and noticeably better joint function; others benefit less. It is worth having realistic expectations and discussing the likely outcome for your particular joint before going ahead, which is part of what the assessment appointment is for.
Side effects
Common side effects are temporary pain or swelling at the injection site. Infection and allergic reactions are rare. Tell us about any allergies or medical conditions before the procedure.
After your injection
Avoid strenuous activity involving the treated joint for about 24 to 48 hours afterwards. You will be given specific post-treatment instructions at your appointment.
What does it cost?
The fee covers the medication, the sterile consumables and delivery of the injection under ultrasound guidance — there is no separate charge for the guidance. Current fees are on our treatment price list.
Informed Consent
Please follow the link: Informed consent for hyaluronic acid injections
Written by Suegnet Meyer, Advanced Practice Musculoskeletal Physiotherapist and MSK Sonographer. HCPC registered [PH55635]. Chartered Society of Physiotherapy member [66175].