More than 55 million adults in the U.S. are affected by osteoarthritis, the most common form of arthritis. It occurs when the connective tissue (cartilage) covering the bones in the joints breaks down and wears out. People with osteoarthritis experience pain, stiffness and swelling in their joints.
There is no cure for osteoarthritis. While the condition can worsen over time, nonsurgical and surgical treatment options can relieve symptoms. Doctors usually first prescribe medications, cortisone injections and physical therapy. Surgery to replace joints is an option for people who have more severe joint damage or when conservative treatments don’t bring relief.
Hyaluronic acid injections, also called viscosupplementation injections or lubricating shots, are another treatment option. “Some people don’t respond to other treatments and want to avoid or are not candidates for surgery. If these individuals have mild to moderate osteoarthritis, hyaluronic acid injections may relieve their symptoms,” says Eddie El-Yussif, D.O., an orthopedic surgeon at Henry Ford Health.
How Do Hyaluronic Acid Injections Work?
Hyaluronic acid injections help slow the progression of osteoarthritis by:
Do You Have Osteoarthritis?
- Lubricating the joint: Osteoarthritis causes loss of synovial fluid, which lubricates joints. Hyaluronic acid is a natural component of this fluid. These injections contain a synthetic form of hyaluronic acid to replenish the lubricating fluid that helps the joint move more easily.
- Reducing inflammation: The injections contain medication to reduce joint inflammation and relieve pain and swelling.
- Repairing damaged cartilage: Hyaluronic acid injections stimulate cartilage cells (chondrocytes) to produce more natural hyaluronic acid and other substances to support joint health.
Dr. El-Yussif notes that some people may benefit from alternating cortisone and hyaluronic acid injections. “Cortisone injections may relieve pain faster but typically last only two to three months. Continued use of corticosteroid injections can also have a negative effect on cartilage and the body’s hormonal system, such as the adrenal gland.”
Cortisone injections also increase blood sugar (glucose) levels. Hyaluronic acid injections don’t affect blood sugar, making them a better alternative for people with diabetes. They may also provide pain relief for longer than cortisone—up to six months.
Who Are Hyaluronic Acid Injections For?
Research on the effectiveness of hyaluronic acid injections is mixed. Some studies show the injections are effective, while others suggest they offer minimal benefit.
In 2021, the American Academy of Orthopedic Surgeons recommended against routine use of hyaluronic acid injections for osteoarthritis. Yet they do acknowledge that some patients may still benefit from the injections.
These injections are not an effective treatment for people with severe or bone-on-bone arthritis. But they may be an alternative for people with milder symptoms who haven’t gotten relief from other therapies.
Hyaluronic acid injections also provide an alternative to surgery. For example, some people with osteoarthritis in the knee may be unable to take time off work for knee replacement surgery. Other people may not be candidates for surgery because of serious health conditions such as major heart disease. “Hyaluronic acid injections offer these individuals another treatment that may improve their quality of life,” says Dr. El-Yussif.
Hyaluronic Acid Injection Side Effects
The most common side effect of hyaluronic acid injections is pain in the joint or at the injection site. This discomfort often improves in one to two days.
These injections aren’t suitable for everyone. For example, some hyaluronic injections contain byproducts of eggs and poultry, which may cause allergic reactions in some people. The injection is also not recommended for people with any active infection in their joints or other parts of their body.
“Pain and stiffness from osteoarthritis can interfere with your ability to go about your daily routine. Your doctor can help determine whether hyaluronic acid injections may be appropriate for your treatment plan,” says Dr. El-Yussif. “Taking certain supplements, managing your weight and exercising can also help relieve joint pain.”
Reviewed by Eddie El-Yussif, DO, FAAOS, an orthopedic surgeon who sees patients at Henry Ford Macomb Health Center - Chesterfield and Henry Ford Orthopedics - Seville in Clinton Township.
