Published: May 14, 2025
Hyaluronan injections are becoming an increasingly popular treatment option for individuals suffering from osteoarthritis, particularly in the knee. Hyaluronan injections provide relief by supplementing the naturally occurring hyaluronic acid in your joints, which can diminish due to osteoarthritis. This comprehensive guide explores everything you need to know about this treatment option, from how it works to what you can expect during and after the procedure.
What Are Hyaluronan Injections?
Hyaluronan injections, also known as viscosupplementation or hyaluronic acid injections, are medical treatments used to relieve joint pain caused by osteoarthritis. These injections contain a substance that mimics the natural joint fluid called hyaluronic acid, which is found in the synovial fluid of your joints. In a healthy joint, this fluid works as a lubricant and shock absorber, allowing cartilage-covered bone ends to glide smoothly against each other.
When you have osteoarthritis, the quantity and quality of hyaluronic acid in your joints decrease, leading to pain, stiffness, and reduced mobility. Hyaluronan injections aim to restore some of the cushioning and lubricating properties to the joint, potentially reducing pain and improving function.
Common brands of hyaluronan injections include:
- Euflexxa (1% Sodium hyaluronate)
- Orthovisc (High-molecular-weight hyaluronan)
- Synvisc (Hylan G-F20)
- Hyalgan (Sodium hyaluronate)
- Supartz/Supartz FX (Sodium hyaluronate)
- Durolane
- Monovisc
- Gel-One
How Hyaluronan Works in Joints
To understand how hyaluronan injections work, it’s important to first understand the structure of a healthy joint versus an osteoarthritic joint.
Hyaluronic acid is a naturally occurring complex sugar molecule (polysaccharide) that plays a crucial role in joint health. It provides several key functions:
Lubrication
Acts as a lubricant between cartilage surfaces, allowing joints to move smoothly with minimal friction.
Shock Absorption
Helps absorb impact and pressure on the joint during movement and weight-bearing activities.
Nutrition
Assists in providing nutrients to the cartilage, which lacks direct blood supply.
Anti-inflammatory
May help decrease inflammation in the joint, reducing pain and swelling.
The molecular structure of hyaluronic acid is what gives it these unique properties:
In osteoarthritis, both the quantity and quality of hyaluronic acid in the joint decrease. The viscosity and elasticity of the synovial fluid are reduced, leading to increased joint friction, pain, and further cartilage damage. Studies on knee pain causes have shown that this deterioration of hyaluronic acid is a significant factor in joint discomfort and reduced mobility.
When hyaluronan is injected into an affected joint, it aims to temporarily restore some of these properties, potentially:
- Improving lubrication between joint surfaces
- Enhancing shock absorption capabilities
- Reducing pain signals from the joint
- Decreasing inflammation
- Potentially stimulating the body’s own production of hyaluronic acid
Who Can Benefit from Hyaluronan Injections?
Not everyone with joint pain is a suitable candidate for hyaluronan injections. These injections are typically recommended for patients who:
- Have been diagnosed with mild to moderate osteoarthritis, particularly in the knee
- Have not found sufficient relief from conservative treatments such as:
- Over-the-counter pain medications (acetaminophen, NSAIDs)
- Physical therapy
- Exercise programs
- Weight loss (if applicable)
- Supportive devices (braces, walking aids)
- Want to postpone more invasive procedures like joint replacement surgery
- Cannot take certain pain medications due to side effects or other medical conditions
Who Should NOT Receive Hyaluronan Injections:
- People with a bleeding disorder or taking blood thinners
- Those with skin infections or conditions at the injection site
- Individuals with joint infections
- People with certain allergies (some products are derived from rooster combs and may not be suitable for those with bird or egg allergies)
- Patients with severe, bone-on-bone osteoarthritis (may not respond as well)
The Arthritis Foundation notes that while hyaluronan injections are primarily approved for knee osteoarthritis, doctors sometimes use them off-label for other joints such as hips, shoulders, and ankles.
The Hyaluronan Injection Procedure
The procedure for receiving hyaluronan injections is relatively straightforward and is typically performed in a doctor’s office. Here’s what you can expect:
The Hyaluronan Injection Process
1-Preparation
The skin around the joint is cleaned and may be numbed with a local anesthetic. Some doctors use ultrasound guidance to ensure proper needle placement.
2-Joint Aspiration
If excess fluid has built up in the joint, your doctor may first remove (aspirate) it to relieve pressure and swelling.
3-Injection
The hyaluronic acid solution is injected directly into the joint space using a fine needle.
4-Post-Injection
You may need to rest the joint briefly. Your doctor might apply a bandage or ice to the injection site.
5-Follow-Up
Depending on the type of hyaluronan product used, you may need to return for additional injections in a series.
The entire procedure typically takes less than 30 minutes. Most patients can resume their normal activities immediately after the injection, though it’s generally advised to avoid strenuous activities, such as jogging, heavy lifting, or standing for long periods, for about 48 hours after receiving the injection.
According to the Mayo Clinic, the treatment protocol varies depending on the specific hyaluronan product used:
- Some products require a single injection
- Others require a series of 3-5 weekly injections
- The full treatment course may be repeated after six months if beneficial
Effectiveness of Hyaluronan Injections
The effectiveness of hyaluronan injections for osteoarthritis varies from person to person. Research on their efficacy has yielded mixed results, and medical organizations differ in their recommendations.
Here’s what current research suggests:
- Pain relief typically begins within a few days to several weeks after injection
- Benefits may last for approximately 6 months in responsive patients
- Effects tend to be modest compared to placebo in large clinical trials
- Some patients experience significant improvement while others notice little difference
- Response may be better in patients with mild to moderate osteoarthritis compared to those with severe disease
- High molecular weight hyaluronic acid products may provide better results than lower molecular weight versions
What the Research Shows:
A 2022 systematic review published in the journal BMJ analyzed trials involving over 6,000 patients and found that hyaluronic acid injections were only slightly better than placebo for knee osteoarthritis. However, the researchers acknowledged that certain subgroups of patients might benefit more than others.
Another study published in Rheumatology International showed that repeated courses of hyaluronan injections could provide continued pain relief for up to two years, with a good safety profile.
Organizations like the American College of Rheumatology (ACR) have recently changed their position from noncommittal to a conditional recommendation against hyaluronan injections for knee osteoarthritis. However, the European Alliance for Associations of Rheumatology (EULAR) maintains positive recommendations for these injections.
The decision to try hyaluronan injections should be made in consultation with your healthcare provider, taking into account your specific situation, including the severity of your osteoarthritis, previous treatments attempted, and your overall health status.
Types of Hyaluronan Products: A Comparison
Several different hyaluronan products are available for injection, each with unique characteristics. Understanding these differences can help you discuss options with your healthcare provider.
| Product | Source | Molecular Weight | Treatment Schedule | Notable Features |
|---|---|---|---|---|
| Euflexxa | Bio-engineered (non-avian) | 2.4-3.6 million daltons | 3 weekly injections | Safe for patients with bird/egg allergies |
| Synvisc/Synvisc-One | Avian-derived | 6 million daltons | 3 weekly injections or 1 single injection | Chemically cross-linked for longer duration |
| Orthovisc | Avian-derived | 1-2.9 million daltons | 3-4 weekly injections | High concentration for better lubrication |
| Hyalgan | Avian-derived | 500,000-730,000 daltons | 3-5 weekly injections | One of the first FDA-approved products |
| Monovisc | Bio-engineered | 1-2.9 million daltons | Single injection | Convenient single-dose treatment |
| Durolane | Bio-engineered | ~1 million daltons | Single injection | Stabilized hyaluronic acid for extended duration |
Higher molecular weight products tend to have better viscoelastic properties and may provide longer-lasting benefits, but they may also have a higher risk of inflammatory reactions. The choice between products often depends on factors such as your medical history, convenience of the injection schedule, and insurance coverage.
Side Effects and Risks
Hyaluronan injections are generally considered safe, but like any medical procedure, they do carry some risks and potential side effects.
Common Side Effects
- Pain, swelling, or warmth at the injection site
- Temporary increase in joint pain
- Joint stiffness
- Minor bruising
- Redness at the injection site
These effects are usually mild and resolve within a few days. Applying ice to the area can help alleviate discomfort.
Less Common Risks
- Allergic reactions (more common with avian-derived products)
- Injection flare/pseudoseptic reaction (severe temporary inflammation)
- Joint infection (very rare)
- Bleeding (particularly in patients on blood thinners)
- Baker’s cyst formation or worsening
When to Seek Medical Attention
Contact your healthcare provider immediately if you experience:
- Severe pain that worsens rather than improves
- Significant swelling, redness, or warmth in the joint
- Fever or chills
- Inability to move or bear weight on the joint
- Any signs of allergic reaction such as rash, itching, or difficulty breathing
According to Mayo Clinic, it’s essential to inform your healthcare provider about any medications you’re taking, including over-the-counter drugs and supplements, as these may interact with the treatment or increase certain risks.
Cost and Insurance Considerations
The cost of hyaluronan injections can vary significantly depending on several factors:
- The specific product used
- The number of injections required
- Geographic location
- Facility fees
- Provider charges
Without insurance, a single hyaluronic acid injection can cost between $300 and $1,000. For products requiring a series of injections, the total cost for a complete treatment course can range from $900 to $5,000.
Insurance Coverage
Insurance coverage for hyaluronan injections varies:
- Medicare Part B typically covers hyaluronan injections for knee osteoarthritis if deemed medically necessary, but may limit the frequency of treatments.
- Private insurance plans may cover these injections, often requiring prior authorization and documentation that other treatments have been tried first.
- Some plans may have specific preferred products they will cover.
- Most insurance plans will not cover hyaluronan injections for joints other than the knee, as these are considered “off-label” uses.
Always check with your insurance provider before proceeding with treatment to understand your coverage and potential out-of-pocket costs.
Some manufacturers offer patient assistance programs that can help reduce costs. Ask your healthcare provider or check the manufacturer’s website for information about these programs.
Alternatives to Hyaluronan Injections
If you’re considering hyaluronan injections, it’s worth knowing about other treatment options that might help manage your osteoarthritis symptoms:
Non-Invasive Approaches
- Physical therapy
- Low-impact exercise
- Weight management
- Braces or assistive devices
- Hot/cold therapy
- Acupuncture
Medications
- Acetaminophen (Tylenol)
- NSAIDs (ibuprofen, naproxen)
- Topical pain relievers
- Duloxetine (Cymbalta)
- Tramadol (for short-term use)
Other Injections
- Corticosteroid injections
- Platelet-rich plasma (PRP)
- Stem cell therapy
- Prolotherapy
For more severe cases that don’t respond to conservative treatments, surgical options include:
- Arthroscopic surgery to remove damaged tissue
- Osteotomy to realign the joint
- Partial or total joint replacement
The most appropriate treatment approach depends on factors such as the severity of your osteoarthritis, your overall health, lifestyle, and treatment goals. Many people find that a combination of treatments works best for managing their symptoms. Visit kneepaincause.com for more detailed information about various treatment options for knee osteoarthritis.
Conclusion: Is Hyaluronan Injection Right for You?
Hyaluronan injections represent one option in the arsenal of treatments for osteoarthritis. While not a cure for the underlying condition, they may provide temporary relief from pain and improved joint function for some patients, potentially delaying the need for more invasive procedures.
The ideal candidate for hyaluronan injections typically:
- Has mild to moderate osteoarthritis, particularly of the knee
- Has not achieved adequate relief with conservative measures
- Is looking to avoid or delay surgery
- Does not have contraindications like joint infections or relevant allergies
The controversy surrounding the effectiveness of these injections highlights the importance of individualized care. What works for one person may not work for another, and expectations should be realistic—hyaluronan injections may provide modest improvement rather than complete relief.
As with any treatment decision, it’s essential to have a thorough discussion with your healthcare provider about the potential benefits, risks, and alternatives based on your specific situation. Together, you can determine whether hyaluronan injections are a reasonable option in your overall osteoarthritis management plan.
Key Takeaways About Hyaluronan Injections
- They supplement the naturally occurring hyaluronic acid in joints affected by osteoarthritis
- They may provide pain relief and improved function for approximately 6 months
- Effects are typically modest and vary from person to person
- They are generally safe with minimal side effects
- They can be repeated if beneficial, usually after 6 months
- They are primarily used for knee osteoarthritis but may be used off-label for other joints
- Insurance coverage varies, and costs can be substantial without coverage
References and Additional Resources
- Mayo Clinic: Hyaluronic Acid (Injection Route)
- Arthritis Foundation: Hyaluronic Acid Injections for Knee Pain
- American College of Rheumatology: Hyaluronic Acid
- KneePainCause.com: Comprehensive Resources for Knee Pain
This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider regarding any medical condition or treatment.
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