Hyaluronic acid injections are used to treat arthritis, especially in the hip and knee. But some research suggests they may not be effective. Will they work for you?

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Hyaluronic acid is a naturally occurring substance in the body that helps lubricate and cushion tissues, such as the joints.

In people with osteoarthritis — a painful degenerative joint disease — levels of hyaluronic acid decline, leading to less cushion and lubrication between joints, which results in pain.

Due to this, hyaluronic acid injections have soared in popularity as a way to replenish joints and ease pain. However, recent research has argued that they work no better than a placebo. This may have you wondering if they’re worth trying or if you should skip them.

This article discusses hyaluronic acid injections and whether they’re effective in reducing osteoarthritis pain.

Hyaluronic acid injections — also known as viscosupplementation — are a type of medical treatment used to ease osteoarthritis pain, usually in the knees, hip, or shoulder.

According to 2015 research, procedures involve injecting a form of hyaluronic acid into the knee, hip, shoulder, or other joint. They’re used as a way to supplement hyaluronic acid that is progressively lost in people with osteoarthritis or gradually with age.

Common brand names include:

  • Durlane
  • Euflexxa
  • Gel-One
  • Hyalgan
  • Hyalgan LL
  • Monovisc
  • NeoVisc
  • Orthovisc
  • Supartz
  • Supartz FX
  • SynVisc
  • SynVisc One

These injections are not the same as dermatological hyaluronic acid injections. Those injections are used as a cosmetic procedure to enhance the plumpness and appearance of the skin.

Healthcare professionals most often recommend hyaluronic acid injections to treat osteoarthritis pain when other first-line options (e.g., pain medications, physical therapy) or glucocorticosteroid injections have not worked.

They’re most often given to those with knee osteoarthritis, which is one of the most common types of arthritis.

Hyaluronic acid injections are highly controversial in the medical and research community. This is because many studies have found little benefit to their use.

In fact, the American College of Rheumatology and Arthritis Foundation guidelines from 2019 recommend against hyaluronic acid injections for the treatment of osteoarthritis, due to insufficient evidence of their effectiveness.

A 2022 analysis of 24 studies with a total of 8,997 participants found that hyaluronic acid injections had no clinically meaningful improvements in knee osteoarthritis pain compared with a placebo.

Other research from 2018 on hip osteoarthritis also found that hyaluronic acid injections had no significant improvements in pain scores compared with a placebo. A 2019 research review had similar findings.

However, some experts argue that hyaluronic acid injections have been effective in their clinical practice. In fact, the European Experts on Osteoarthritis group recommends it as a treatment for mild-to-moderate osteoarthritis pain.

A 2019 randomized trial found that hyaluronic acid injections may help alleviate mild-to-moderate osteoarthritis pain.

Yet clinical significance is still hotly debated amongst experts. In particular, many argue that while many studies may find “statistical significance” in pain scores, they actually do not have clinically significant results.

This means that while the scores may differ from a mathematical standpoint, the pain levels aren’t meaningfully different in real life.

In fact, due to this, the American Academy of Orthopedic Surgeons (AAOS) recommends against the routine use of hyaluronic acid injections for osteoarthritis in its 2021 practice guidelines. Yet the AAOS does acknowledge that some patients may still find benefit from the injections in certain cases.

To date, most research suggests hyaluronic acid injections will not lead to meaningful improvements in osteoarthritis pain. However, it’s best to talk with your doctor, who can assess your unique situation.

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.

If medically necessary, Medicare will reimburse the cost of hyaluronic acid injections for osteoarthritis of the knee. However, it does not cover other forms of osteoarthritis, such as for the hip or shoulder.

Private insurance companies may also cover hyaluronic acid injections, though the coverage may vary depending on your plan.

What are the side effects of hyaluronic acid injections?

Generally, hyaluronic acid injections are considered safe. However, some people may experience temporary pain, redness, discoloration, bruising, or swelling at the injection site. In rare cases, infection, allergic reaction, or bleeding may occur.

How long do hyaluronic acid injections last?

Hyaluronic acid injections will last between 6 months and 1 year for most people. In some cases, it may last only a few weeks.

Who should not get hyaluronic acid injections?

Hyaluronic acid injections are not recommended for people with inflammatory arthritis, knee joint infections, or skin disease near the site of infection.

They’re also not recommended as a first-line treatment and are usually recommended only if other treatments, such as pain medications or glucocorticosteroid injections, do not work.

How long does it take for hyaluronic acid injections to work?

If the injections are effective, people may notice improvements in pain within 4 weeks of treatment. Sometimes it can take closer to 8–12 weeks.

Hyaluronic acid injections — also known as viscosupplementation — are a common treatment for osteoarthritis pain management.

Despite their popularity, a growing number of research studies have shown that hyaluronic acid injections provide little to no pain relief in those with hip or knee osteoarthritis.

In fact, the AAOS, the American College of Rheumatology, and the Arthritis Foundation advise against this procedure in most cases.

That said, some experts argue some people may experience improvements in pain, especially if other treatments have failed to work. That’s why some doctors may still provide this therapy.

Ultimately, it’s best to consult your healthcare professional, who can help you determine the best treatment for you.