Osteoarthritis of the Knee: Hyaluronic Acid Joint Injections

In the U.S., almost 21 million adults are living with osteoarthritis. And one of the body’s critical joints, the knee, is the most frequently affected. More than 30% of people over 50 have knee osteoarthritis. So do a whopping 80% of those over 65. In fact, about 100,000 people in the U.S. can’t get from their bed to the bathroom because of osteoarthritis of the knee.

Getting hyaluronic acid joint injections is one treatment that may ease the pain and stiffness of osteoarthritis. Hyaluronic acid joint injections are quick and relatively painless. They’ve been on the market for more than a decade. But studies on effectiveness show mixed results.

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Should you consider hyaluronic acid joint injections? There’s no simple answer. Experts say it depends on your symptoms, the other treatments you’ve tried, and your own preference.

What Are Hyaluronic Acid Joint Injections?

Hyaluronan occurs naturally in the synovial fluid that surrounds the joints. Hyaluronan is a thick liquid that helps lubricate the joints, making them work more smoothly.

In people with osteoarthritis, the consistency of hyaluronan becomes thinner. The idea behind hyaluronic acid joint injections is to replace some of the natural supply that’s been lost.

The procedure is simple. Hyaluronic acid is injected directly into the cavity around the knee joint. A typical course of treatment is one injection a week for three to five weeks. While it has only been FDA-approved for people with osteoarthritis of the knee, it’s sometimes tried in other joints as well.

There are various different brands of hyaluronan including :


While the types do differ in some ways, none has been shown to work better or worse than another.

Effectiveness of Hyaluronic Acid Joint Injections

How well do hyaluronic acid joint injections work? The answer isn’t clear. Many studies have sought to answer the question and come up with different results.

For instance, one study published in Rheumatology found that in the short term, hyaluronan was no better at reducing joint pain than a placebo injection of salt water. An analysis of seven different studies published in the Journal of Family Practice did not recommend the treatment in its conclusion, since the benefits — if it had any at all — were so slight.

But a similar analysis of twenty studies– published in The Journal of Bone and Joint Surgery — found that injections of hyaluronan did reduce pain and increase the function of the knee in people with osteoarthritis.

In studies that show effectiveness, pain relief lasts up to six months or a year. It works better in some people than in others. People who are older or have advanced osteoarthritis may be less likely to be helped.

Making Your Decision on Hyaluronic Acid Joint Injections

What role should hyaluronic acid joint injections play in your personal treatment plan?

Typically, hyaluronan is only tried when other treatments — like physical therapy, exercise, and injections with painkillers and steroids — have failed, say the experts.

One advantage of hyaluronic acid joint injections is that the side effects are mild. The most common are swelling and discomfort at the site of the injection. Since the risks of hyaluronan are small, your doctor may feel it is worth a try — especially if your only other option is surgery.

Hyaluronan may also be a good choice if the side effects of other treatments aren’t acceptable.

For instance, some people cannot take common painkillers such as aspirin, Advil, Aleve, or Motrin because of the risk of gastrointestinal bleeding. And steroid injections, another common treatment for osteoarthritis, can lead to joint deterioration if overused.


If you’re interested in hyaluronic acid joint injections, talk to your doctor. Given that side effects are mild and generally rare, your doctor may agree to give it a try. Make sure to check with your insurance company first. Not all insurance companies will cover the treatment, which is expensive.




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