Hyaluronic acid (HA) injections have become an established treatment option for managing joint pain, particularly in osteoarthritis. Understanding how HA works, the conditions it best treats, who should consider it, and the associated risks can help patients make informed decisions about this therapy.
How Does Hyaluronic Acid Work?
Hyaluronic acid is a natural substance found in the synovial fluid of joints, where it serves as a lubricant and shock absorber. In osteoarthritis and other joint diseases, the natural level and quality of HA decline, leading to increased friction and pain.
Injecting HA into the joint aims to restore this lubricative environment, improving joint movement and cushioning. Beyond mechanical effects, HA may also have mild anti-inflammatory properties and can help stimulate the production of the body’s own HA in the joint. This dual action can contribute to reduced pain and improved function.
Indications Best Treated With Hyaluronic Acid
HA injections are most commonly used to treat knee osteoarthritis, especially in patients who have not responded adequately to conservative measures such as physical therapy and NSAIDs.
Mild to moderate knee osteoarthritis pain
Osteoarthritis in hip, hand, and shoulder joints
Chronic joint pain from degenerative or post-traumatic causes
Tendonitis (e.g., Achilles tendonitis, tennis elbow)
Mechanical meniscus pathology with osteoarthritis
It is generally considered when patients want to avoid or delay joint replacement surgery. Unlike corticosteroids that provide quicker but shorter relief, HA tends to have a slower onset with effects lasting several months.
Who Are Good Candidates for HA Injections?
Ideal candidates for HA injections are adults with:
Symptomatic knee osteoarthritis confirmed by imaging, who have persistent pain affecting daily activities despite standard non-invasive treatments.
No active infections or skin problems near the injection site
No allergies to HA or its components.
Severe arthritis or advanced joint damage may not benefit as much.
HA is also suitable for patients who prefer a non-surgical approach or for whom surgery is contraindicated.
Patients intolerant to NSAIDs or corticosteroids
As adjunct to physical therapy and lifestyle changes
Not for active joint infections or inflammatory arthritis flare
How to Prepare for an HA Injection
Ask your injector whether to pause blood thinners (warfarin, DOACs, high‑dose aspirin) or antiplatelets; many clinics continue them, but some adjust on a case‑by‑case basis.
If safe for you, minimize other bleeding‑risk agents for several days beforehand (e.g., high‑dose NSAIDs, fish oil, high‑dose vitamin E, ginkgo, garlic, ginseng).
Ensure your clinician knows all meds, supplements, and allergies, and any history of reactions to injections or local anesthetics.
Discuss with your provider if you may have insurance benefits that cover this injection.
What to Expect During an HA Injection
A general assessment, including your vitals, will be performed. There are a few different types of HA to choose from, and we will discuss the best option based on your needs.
The injection will be performed under ultrasound guidance, and the injection is generally well-tolerated and not uncomfortable. We will discuss this at length before the procedure.
Most people choose to drive themselves home after the procedure, but if you are sensitive to needles or have any concerns, having a ride planned is always a good idea. Most people can also return to their daily activities immediately after the procedure.
Potential Risks
Hyaluronic acid injections are generally safe with a low incidence of side effects. The most common risks include temporary pain, swelling, or warmth at the injection site. Rarely, local allergic reactions or infections can occur.
Unlike corticosteroids, HA does not typically cause systemic side effects or weaken tendons or cartilage. Proper sterile technique during injection minimizes risks.
What to Expect After the Procedure
Normal Post-Injection Effects
Mild pain or aching in the joint for up to 48 hours.
Slight swelling and sometimes warmth over the area.
Possible bruising at the injection site.
Rarely, a fluid buildup may occur and resolve on its own.
Aftercare Steps
Rest the joint and avoid strenuous exercise for 24–48 hours.
You may use ice packs to reduce swelling and discomfort.
Avoid long periods of standing, lifting, or repetitive motion for the first day.
Keep the area clean to reduce the risk of infection.
Follow any additional instructions provided by your health care team.
A plan to return to activity and exercise will be devised with your injecting physician and physiotherapist to maximize the benefits of the procedure.
Summary
Hyaluronic acid injections offer a therapeutic option that mimics the natural joint lubricant to relieve pain and improve mobility, primarily in knee osteoarthritis. They are best suited for patients with mild to moderate disease who have not found relief with other treatments and who prefer to avoid surgery. While side effects are rare and mostly mild, careful patient selection and procedural care are important to ensure safety and effectiveness.
As research continues to evolve, HA remains an important part of the multidisciplinary approach to managing joint health, emphasizing minimally invasive treatments that support patient quality of life. Discussions with healthcare providers can help patients understand if HA injections are appropriate for their specific joint condition and treatment goals.
