Monday, June 17, 2024
HomeInjectionHyaluronic Acid Knee Injection Procedure

Hyaluronic Acid Knee Injection Procedure

Who Can Take Hyaluronan Injections

HSS Minute: Hyaluronic Acid Injections for Knee Osteoarthritis

Hyaluronan injections can be used to treat arthritis. But theyre usually only prescribed if other treatments havent worked first.

NICE is an organisation that provides information about treating and caring for different conditions in the UK. It currently doesnt recommend using hyaluronan injections for osteoarthritis.

NICE suggests that hyaluronan injections may reduce pain over six months. But the injections may cause short-term inflammation in the knee.

However, some doctors dont agree with this advice and continue to legally prescribe hyaluronan injections.

You may want to discuss if hyaluronan injections are an option for you with your healthcare team. This is because different NHS locations may have different policies.

Hyaluronan injections are also available at private clinics around the UK, where you pay for the treatment yourself.

You wont get hyaluronan injections if you have:

  • a bleeding or blood clotting disorder, such as haemophilia
  • certain allergies
  • an infection in your knee or in the skin around your knee.

Research Comparing Prp Injections Cortisone Injections And Hyaluronic Acid Injections

Doctors wrote in a January 2019 study that PRP injections, cortisone injections, and hyaluronic acid injections are considered equally effective at relieving patient symptoms at three months, at 6, 9, and 12 months the PRP injections delivered significantly better results.

A July 2020 study published in the Journal of Pain Research also suggested that PRP injections provided better results for patients than hyaluronic acid injections. The studys conclusions were: Besides significantly higher satisfaction belonging to the group, there was a statistically significant improvement in pain and function scores at 12 months compared to hyaluronic acid injections

In research published in the Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, PRP was shown to provide significant healing of the meniscus as well as out out-perform hyaluronic acid in patients with knee joint cartilage degeneration. Similar results were documented in the journal Archives of physical medicine and rehabilitation.

An August 2021 paper in the Orthopaedic Journal of Sports Medicine suggests however that corticosteroid and hyaluronic acid injections are favored for different knee problems, while PRP currently has insufficient evidence to make a conclusive recommendation for or against its use.

What Are The Side Effects Of Hyaluronic Acid Shots

The shots are usually low risk, but some side effects may occur. Typical side effects include pain, swelling, heat, redness, and/or fluid build-up around the knee, Dr. Miller says. Rest and ice afterward can help prevent the typical side effects.

More rarely, infections of the joint are possible, as is damage to other parts of the knee, he says. However, properly trained physicians will deliver an injection with very little risk of complications, Dr. Miller says.

Read Also: Pain In The Back Of The Knee When Bent

Side Effects And Risks Of Hyaluronic Acid Injections For Knee Osteoarthritis

Hyaluronic acid injection for the knee is usually considered a safe procedure, but like any medical procedure, it may carry some side effects and risks.

The most common side effects of this procedure include mild swelling and pain at the injection site.

Risks, although rare, may include pseudo-septic arthritic reactions.6Maheu E, Rannou F, Reginster JY. Efficacy and safety of hyaluronic acid in the management of osteoarthritis: Evidence from real-life setting trials and surveys. Semin Arthritis Rheum. 2016 45:S28-33.,7Idrissi Z, Benbouazza K, Fourtassi M, et al. Acute pseudo-septic arthritis following viscosuplementation of the knee. Pan Afr Med J. 2012 12:44. Pseudo-septic arthritis is a severe inflammatory reaction or flare at the injection site. If this reaction occurs, it is usually seen within the first three days of injection and may be treated with non-steroidal anti-inflammatory drugs or steroids.7Idrissi Z, Benbouazza K, Fourtassi M, et al. Acute pseudo-septic arthritis following viscosuplementation of the knee. Pan Afr Med J. 2012 12:44.

Other rare risks include infections, allergic reactions, or bursitis. If such signs or symptoms occur, it is advised to see a doctor immediately.

How Do Prolotherapy Injections Work For Knee Pain

Hyaluronic Acid Injection Los Angeles

In this section, we will discuss Prolotherapy knee osteoarthritis injections. Prolotherapy is a remarkable treatment in its simplicity. The treatment can help many patients avoid joint replacement. But it is not a miracle cure. The research and evidence for how Prolotherapy may help you are presented here and intermingled with our own 28+ years of empirical observation of patient benefit.

A June 2022 paper in the journal Clinical Rehabilitation describes the controversies and benefits of Prolotherapy injections. In examining previously published data, the researchers found: Compared with placebo injection and noninvasive control therapy, dextrose Prolotherapy had favorable effects on pain, global function, and quality of life during the overall follow-up. The researchers then concluded: Dextrose Prolotherapy may have dose-dependent and time-dependent effects on pain reduction and function recovery, respectively, in patients with knee osteoarthritis. Due to remarkable heterogeneity and the risk of biases across the included trials, the study results should be cautiously interpreted.

  • These cells then excrete extracellular matrix, which enhances the stability of the joints by tightening and strengthening the ligaments, tendons, and joint stabilizing structures.
  • We have a fascinating article The Extracellular matrix | How comprehensive Prolotherapy repairs cartilage on this website if you would like to research that more.
  • Recommended Reading: Is Knee Pain Related To Heart Problem

    Are There Other Points To Consider About Gel Shots For Knee Arthritis

    Usually, people consider these gel injections when they fail to exercise tablets and cortisone injections. For example, some people cant take common anti-inflammatories like ibuprofen due to stomach ulcers or previous heart attacks. In addition, as the side effects of viscosupplementation injections are minimal, some people consider these injections an alternative to surgery.

    You need to understand that a gel injection should be done with an ultrasound. Ultrasound ensures that hyaluronic acid is injected into the joint and not outside the joint. If you inject hyaluronic acid into the soft tissue, there is a chance that you may experience severe pain and swelling. A recent study shows that a hyaluronic acid injection performed with ultrasound has a much better effect than blind injections . In a study with over 1000 patients who had hyaluronic acid injections for knee arthritis, those who had injections with ultrasound had much fewer rates of knee replacement than those who had blind injections. Moreover, patients with an ultrasound-guided hyaluronic acid injection were 27% less likely to need a subsequent cortisone injeciton for pain.

    What Is The Cost Of Hyaluronic Acid Injections

    The cost of hyaluronic acid injections will vary depending on your location, the brand used, and other medical costs.

    Generally, hyaluronic acid injections can cost anywhere from $200 to a few thousand dollars. This may also depend on the number of injections required and how frequently you need them.

    Also Check: Can You Get Cortisone Shot After Knee Replacement

    Hyaluronic Acid Side Effects

    Since hyaluronic acid is present in the human body, you may not suffer any side effects. However, hypersensitivity, especially in the form of allergies, can be seen in as many as 2-3% of the patients in the initial research. A part of the side effects can be alleviated by using hyaluronic acid coming from non-animal sources, and further research is needed to see what else can be done to reduce hypersensitivity in some even further.

    Summary And Contact Us Can We Help You

    Hyaluronic Acid Knee Injections (Durolane Single)

    We hope you found this article informative and it helped answer many of the questions you may have surrounding your knee problems and knee instability. If you would like to get more information specific to your challenges please email us: Get help and information from our Caring Medical staff

    This article was updated June 6, 2022

    Read Also: What Could Cause Knee Pain And Swelling

    What To Expect After Corticosteroid Or Hyaluronic Acid Injections

    Most people can return home or to work immediately after the injection takes place. The site of the injection may be swollen or tender for one or two days. Doctors may recommend applying ice two or three times a day or taking an over-the-counter medication to relieve pain and reduce swelling.

    It may take several weeks to see improvement after a hyaluronic acid injection. Our doctors recommend restricting high-impact activity, such as running, until symptoms improve.

    A person may feel the pain relief effects of corticosteroid injections more quickly than hyaluronic acid, but the results may not last as long. However, each person may respond differently to either of these injections.

    What About Combining Hyaluronic Acid And Prp

    So, there is some evidence that combining PRP and hyaluronic acid is better than one.

    A recent review found that combining PRP with hyaluronic acid is better than PRP alone. This positive effect was found at 3, 6, and 12 months. Also, adding hyaluronic acid to PRP reduces the risk of a flare after a PRP injection.

    Perhaps, this combination will be the norm in the future.

    Don’t Miss: How To Treat Knee Injury

    Side Effects Of Hyaluronic Acid Injections For Knees

    *Disclaimer: Information on is provided for informational purposes only. Self-medication is strictly prohibited. All aesthetic procedures should be provided by the licensed healthcare specialist after the consultation with the personal therapist. The information in this article should not be used for prescribing any medication for the beauty injections.

    All brand and medication descriptions in the article are based on the personal opinion and are not endorsed by The article content was not reviewed for medical validity. Use this article for information and not for a final decision on the procedure.

    Electrical Stimulation Combined With Corticosteroid Injection

    Steroid &  Hyaluronic Acid Injection for Knee Joints. Illustration ...

    Electrical Dry Needling is electric stimulation in needle form. A 2022 study in the Archives of Physical Medicine and Rehabilitation added electric stimulation, in needle form, to a group of knee osteoarthritis patients treatment. In this study, sixty patients with knee osteoarthritis were divided into two groups, one with electrical dry needling plus corticosteroid injection group or corticosteroid injection alone.

    The corticosteroid injection group received one glucocorticoid injection during the study and the electrical dry needling plus corticosteroid injection group received a glucocorticoid injection combined with four sessions of electrical-Electrical Dry Needling.

    Results: Electrical Dry Needling therapy at myofascial trigger points combined with corticosteroid injection is more effective at alleviating pain, improving dysfunction, and global change than corticosteroid injection alone for patients with knee osteoarthritis. Electrical Dry Needling may be an essential part of treatment for knee osteoarthritis rehabilitation. Over the years we have seen patients who initially did very well with some type of electric stimulation therapy. Unfortunately for many the results were not long-lasting and for this and other clinical observations we do not offer this treatment for knee pain.

    Don’t Miss: How Long Is Therapy After Knee Replacement

    Platelet Rich Plasma Injections Comparison

    Platelet Rich Plasma Therapy is a blood injection taken from the patients own blood and reduced down to plasma that is heavy with platelets. Blood plasma platelets hold and encourage many healing growth factors that stimulate healing in degenerated tissues. PRP has also been shown to be superior to hyaluronic acid injections in many studies documented below.

    In our article Platelet Rich Plasma for Knee Osteoarthritis: When it works, when it does not, we point to more research on when the treatment can be successful and when the treatment may not help you.

    Research comparing PRP injections, cortisone injections, and hyaluronic acid injections

    Doctors wrote in a January 2019 study that PRP injections, cortisone injections, and hyaluronic acid injections are considered equally effective at relieving patient symptoms at three months, at 6, 9, and 12 months the PRP injections delivered significantly better results.

    A July 2020 study published in the Journal of Pain Research also suggested that PRP injections provided better results for patients than hyaluronic acid injections. The studys conclusions were: Besides significantly higher satisfaction belonging to the group, there was a statistically significant improvement in pain and function scores at 12 months compared to hyaluronic acid injections.

    Here is a summary of further research findings:

    What Does Hyaluronic Acid Do In The Knee Joint

    In the osteoarthritic knee, the quality and quantity of hyaluronic acid in the joint fluid reduces causing pain, stiffness, and swelling in the joint. ReadWhat Is Hyaluronic Acid?

    A healthy knee joint contains up to 4 mL of joint fluid.3Kraus VB, Stabler TV, Kong SY, Varju G, McDaniel G. Measurement of synovial fluid volume using urea. Osteoarthritis Cartilage. 2007 15:1217-20. Hyaluronic acid is a key component of the joint fluid. It gives the joint fluid its viscous, slippery quality, which does the following:

    • Enables the bones’ cartilage-covered surfaces to glide against each other, thereby reducing joint friction
    • Adds cushion to protect joints during impact

    See Knee Anatomy

    Joints affected by osteoarthritis typically have a lower concentration of hyaluronic acid in their joint fluid than healthy joints, and therefore less protection against joint friction and impact.4Altman RD, Manjoo A, Fierlinger A, Niazi F, Nicholls M. The mechanism of action for hyaluronic acid treatment in the osteoarthritic knee: a systematic review. BMC Musculoskelet Disord. 2015 16:321. Published 2015 Oct 26. doi:10.1186/s12891-015-0775-z Experts believe this further accelerates the joint degeneration process, setting in place a vicious cycle.

    Don’t Miss: Why Is My Knee Sore

    What To Expect After A Hyaluronic Acid Injection

    Everyone responds to hyaluronic acid injections a little differently. You might have almost immediate relief, or it could take a few weeks for the inflammation and pain in your knees to subside. Soon you find that you can move more easily and without pain.

    Most patients have pain relief for 4-6 months. You can have hyaluronic acid injections every six months or so. Many patients find that the injections provide enough relief that they can delay or even avoid knee replacement surgery.

    This is especially important if you had a traumatic knee injury in the past, which can increase your risk of early-onset osteoarthritis. Joint replacements last for 10-15 years. With a current average life expectancy of over 72 years, if you can delay a knee replacement, you can avoid additional knee replacement surgeries later in life.

    If you have knee pain thats interfering with your life and want to find out if hyaluronic acid injections can help, .

    One Injection Of Bone Marrow Aspirate Concentrate Stem Cells Versus One Injection Of Prp

    Hyaluronic Acid (HA) Knee Injections

    A January 2022 study published in the journal BioMed Central Musculoskeletal Disorders compared a one-shot single treatment bone marrow-derived stem cell injection vs. a one-shot single treatment PRP injection. Then the patients were monitored for 12 months to assess the effectiveness of the one-shot treatment for their knee pain and function. The researchers wrote: Investigational cell therapies injected intra-articularly, such as bone marrow aspirate concentrate and platelet-rich plasma , have shown safety and therapeutic potency providing patients with pain relief. In the current retrospective comparative study, investigated the differences in pain and functional improvements in patients with symptomatic knee osteoarthritis receiving intra-articular injections of bone marrow aspirate concentrate BMAC vs PRP.

    Pain and functionality scores were measured at baseline and at different time points post-injection over 12 months, using 3 self-administered, clinically validated questionnaires to assess pain intensity, functionality, and knee-related quality of life.

    Don’t Miss: What Do They Do For Arthritis In The Knee

    Hyaluronic Acid Injections For Knee Osteoarthritis


    A and B and HHH MAC 11201 – MAC A
    A and B and HHH MAC 11202 – MAC B
    A and B and HHH MAC 11301 – MAC A
    A and B and HHH MAC 11302 – MAC B
    A and B and HHH MAC 11401 – MAC A
    A and B and HHH MAC 11402 – MAC B
    A and B and HHH MAC 11501 – MAC A
    A and B and HHH MAC 11502 – MAC B

    CPT codes, descriptions and other data only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

    Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is notrecommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services.The AMA assumes no liability for data contained or not contained herein.

    Current Dental Terminology & copy 2021 American Dental Association. All rights reserved.

    Copyright & copy 2022, the American Hospital Association, Chicago, Illinois. Reproduced with permission.No portion of the American Hospital Association copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB& hyphen 04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312& hyphen 893& hyphen 6816.

    Hyaluronan Injections For Knee Cartilage

    Different forms of arthritis are common in the aging population. Not only that, but physically active men and women complain of joint and knee pain even at a younger age. Hyaluronan injections can help some.

    Many physical activities, including running, are high-impact activities. It is safe to conclude that many instances of pain are a result of damaged cartilage. Among other treatments, cortisone has been the predominant one.

    Cortisone reduces instances of pain and swelling and has the potential to significantly reduce local inflammation. With an immediate effect, it has shown promising results, but the issue of regular reapplication and long-term dependence on the medicine made it an unfavorable solution for a common problem. Recently, research has been focusing on the medicinal uses of hyaluronic acid.

    Hyaluronic acid has mostly been used in cosmetic procedures, where it has shown promising results in apparent age-reversing and soothing the fine lines and wrinkles on the face and the neck. A highly viscous liquid with a long life once in the body , it has found its way into medicine and replacing joint lubricant in patients with damaged or worn-out cartilage.

    Read Also: Total Knee Arthroplasty Procedure Steps

    Ten Patients Underwent Intra

    A September 2021 study published in The Archives of Bone and Joint Surgery was designed to compare the effectiveness of intra-articular injection of PRP with hyaluronic acid on mild to moderate knee osteoarthritis.

    How the study was conducted:

    • Ten patients underwent intra-articular PRP injection and 10 others received hyaluronic acid injections.
    • At baseline visits and one, three, six, and 12 months post-injection, clinical assessments were performed using standardized patient self-reporting scores for pain, function, and disability.
    • Physical examinations of the knee, including crepitation and range of motion were performed at each visit.


    • The PRP treatment was ascertained to be safe and caused no adverse effects. Significant improvements in the majority of patients were seen in pain and function.
    • The hyaluronic acid injection, however, caused only one months significant improvement in the majority of patient-reported outcomes.
    • In the majority of visits, the extent of improvements in pain and function were significantly greater in PRP recipients, compared to hyaluronic acid recipients.
    • The ROM in both groups slightly increased after interventions.
    • The frequency of coarse crepitation, which was detected in 100% of the patients in both groups at the baseline visit, decreased significantly to fine crepitation at the first follow-up visit in 80% and 40% of the PRP and hyaluronic acid recipients, respectively.


    Popular Articles