Osteoarthritis (OA) can make even the simplest movements painful. If you've been struggling with knee pain and stiffness, viscosupplementation injections—also known as hyaluronic acid (HA) injections—might be an option to help you move more freely and comfortably. But how well do they really work? And are they worth trying?

What Is Viscosupplementation?

Viscosupplementation is a non-surgical treatment for osteoarthritis that involves injecting hyaluronic acid directly into the knee joint. Hyaluronic acid is a naturally occurring substance in synovial fluid, which lubricates and cushions the joints. As OA progresses, the natural levels of HA decrease, leading to increased joint friction, pain, and stiffness.

How Do HA Injections Work?

Hyaluronic acid injections aim to:

• Restore joint lubrication for smoother movement.
• Reduce pain and inflammation over time.
• Improve mobility and function, making daily activities easier.
• Delay or reduce the need for knee surgery, such as total knee replacement.

Who Is a Good Candidate for Viscosupplementation?

HA injections are typically recommended for patients who:

• Have mild to moderate knee osteoarthritis.
• Have tried physical therapy, NSAIDs, or corticosteroid injections with limited relief.
• Want to delay knee replacement surgery.
• Are looking for a non-invasive pain relief option.

Important Note: Viscosupplementation is not as effective for severe OA, where cartilage is significantly worn down. Talk to your doctor to see if you’re a good candidate.

Do Hyaluronic Acid Injections Really Work?

Research on HA injections shows mixed results, but many patients experience significant pain relief and improved mobility for up to six months.

What the Studies Say:

• Short-term relief: Some studies suggest viscosupplementation can provide better pain relief than placebo injections, especially in early to moderate OA.
  
  • A systematic review and meta-analysis by Concoff et al. found that multiple HA injections (2-4 injections) provided significant pain reliefand improved function compared to a placebo injection, with the greatest benefit observed at 3 and 6 months.
    
  • Altman et al. reviewed the efficacy and safety of repeated courses of HA injections and found that repeated treatments maintained or further improved pain reduction without increasing safety risks. This suggests that repeated HA injections can be effective for long-term management of knee OA.
  • The American Academy of Orthopaedic Surgeons (AAOS) guidelines have shown inconsistent conclusions regarding HA injections. Some meta-analyses included in their guidelines reported small to moderate benefits.
  • The American Society of Pain and Neuroscience (ASPN) in their STEP guidelines also supports the use of HA injections, noting their potential to reduce pain and improve function, particularly with higher molecular weight formulations.

What to Expect During and After the Procedure

The procedure is quick and minimally invasive, usually performed in your doctor’s office:

1. Your knee is cleaned and numbed.
2. Your doctor may remove excess fluid from the joint.
3. Hyaluronic acid is injected directly into the knee.
4. You’ll be advised to rest the knee for 24 hours before resuming normal activities.

Possible Side Effects Include:

• Temporary swelling or stiffness
• Mild pain at the injection site
• Rare allergic reactions or joint inflammation

How Much Do Hyaluronic Acid Injections Cost?

Many insurance plans, including Medicare, cover HA injections if they’re deemed medically necessary.Many insurance plans, including Medicare, cover HA injections if they’re deemed medically necessary. However, not all insurances plans cover the cost of viscosupplementation injections.

Should You Try Viscosupplementation?

Hyaluronic acid injections won't cure osteoarthritis, but they can be a great option for reducing pain and improving mobility without surgery.

Key Takeaways:

• Best for mild to moderate knee OA.
  
• Provides longer-lasting relief than cortisone and have fewer side effects and may last longer..
  
• Can delay the need for knee surgery.
  
• Effects vary—some patients feel significant relief, while others may not.
  • The effects of HA injections may take a few weeks to kick in. Be patient and follow your doctor’s recommendations.

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Wellesley MA 02481

(781) 591-7855

info@bsbortho.com

References:

1. Altman R, Hackel J, Niazi F, Shaw P, Nicholls M. Efficacy and safety of repeated courses of hyaluronic acid injections for knee osteoarthritis: A systematic review. Semin Arthritis Rheum. 2018 Oct;48(2):168-175.
   
2. Concoff A, Sancheti P, Niazi F, Shaw P, Rosen J. The efficacy of multiple versus single hyaluronic acid injections: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2017 Dec 21;18(1):542.
3. Hunter CW, Deer TR, Jones MR, Chang Chien GC, D'Souza RS, Davis T, Eldon ER, Esposito MF, Goree JH, Hewan-Lowe L, Maloney JA, Mazzola AJ, Michels JS, Layno-Moses A, Patel S, Tari J, Weisbein JS, Goulding KA, Chhabra A, Hassebrock J, Wie C, Beall D, Sayed D, Strand N. Consensus Guidelines on Interventional Therapies for Knee Pain (STEP Guidelines) from the American Society of Pain and Neuroscience. J Pain Res. 2022 Sep 8;15:2683-2745.
   
4. Vangsness CT Jr, Adamson TC 3rd, Daley MJ. Consequences on Private Insurance Coverage: The AAOS Clinical Practice Guidelines and Hyaluronic Acid Injections. J Bone Joint Surg Am. 2020 May 20;102(10):920-926.