Hyaluronic Acid Injection

Hyaluronic Acid injections are becoming increasingly popular for individuals with joint pain. The benefit of Hyaluronic Acid injection is that it has less harmful effects than cortisone to joint surfaces and tendons, and symptom relief can last a lot longer. This is important for individuals experiencing pain in a joint that is not responding to conservative treatment.

A Hyaluronic acid injection is a quick and simple procedure that can be repeated without long term detrimental effects to a joint like cortisone injection can have.

Hyaluronic acid injections are generally considered to be very safe, although a few people may experience some minor side effects outlined below. The following information should be helpful in deciding if this treatment might be useful for you.

So what is it?

Hyaluronic Acid (HA) is a Gel like substance that is naturally present throughout the human body. It is present in the body wherever moisture is stored or lubrication between layers of tissue is required to eliminate friction. Its role is to retain water and keep tissues moist and well lubricated. The skin is made up of up to 55% of Hyaluronic Acid. It is also a natural part of the fluid that lubricates your joints. These are key functions of Hyaluronic acid in the body:
  • Storage: it absorbs and stores moisture in enormous quantities
  • Lubrication
  • Transport medium for nutrients
  • Filter for inflammatory molecules
Hyaluronic acid is constantly being broken down and regenerated in the body. As structures like joints age the balance between break down and regeneration is altered leading to more breakdown and less production. This can lead to more watery fluid in the joint that is less able to perform the functions mentioned above. This is part of the process in osteoarthritis which also involves breakdown of the cartilage in the joints which also contains Hyaluronic acid.
Injecting Hyaluronic acid into a joint or tendon sheath essentially helps restore this delicate balance between breakdown and production and improves tendon and joint lubrication.

So what do we do?

Hyaluronic acid is injected into the space in the joint that contains synovial fluid (joint fluid) and works by restoring the normal balance between the breakdown and production of hyaluronic acid. This can help relieve symptoms of pain and stiffness in a joint. If we are performing an injection around a tendon, we inject into the space around the tendon to improve its lubrication and prevent adhesions. Again this can help to relieve symptoms of pain and stiffness around a tendon. One of the more popular Hyaluronic acid injections we perform is into joints with osteoarthritis using Ostenil Plus or Durolane. This requires only 1 injection which can give some patients relief for up to 9-12 months.

What should I expect on the day of the injection?

The clinician performing your injection will perform an ultrasound scan to assess the area and identify where to inject the Hyaluronic acid. Your treating clinician will explain the procedure in more detail on the day based upon the ultrasound examination findings. Most Hyaluronic acid injections are surprisingly quick and comfortable to perform.

 What to expect after an injection of Hyaluronic acid?

You should usually allow a week or two for the effect of the Hyaluronic acid to begin. We recommend that you should avoid strenuous exercise of that area for 2-3 days afterwards due to the possibility of some post-injection discomfort. When having an injection around a tendon, we may advise you to avoid heavy impact and loading activities for a few days due to potential discomfort following the injection.

How many injections will I need?

The benefits of Hyaluronic acid injections is that they can safely be repeated if required. If the injection gave you relief the first time for any length of time, then it is reasonable to inject the area again if symptoms return. There is currently no research to suggest any significant long term harm from having repeat injections of Hyaluronic acid.

If you have an osteoarthritic joint, repeat injections may help prolong the life of that joint, delaying the need for joint replacement.

What are the risks and side effects from Hyaluronic acid injections?

Approximately 1 in 5, may have some post injection pain for up to 48 hours after the injection. This may be in the form of an ache around the area that was injected. This will resolve quickly by itself and can be managed with ice and over-the-counter painkillers if required. As with any injection into the body, there is always a risk of infection. This is extremely rare across all injections administered in all healthcare settings. Around 1 : 50,000 patients may get an infection according to the literature following an injection procedure. The risk is similar to having a standard blood test. We perform a “no touch” aseptic technique to ensure your safety during the procedure.
There are very few other side effects that have been linked with the use of Hyaluronic acid. The products we use contain no animal products and are therefore far less likely to cause any unwanted allergic side effects.
When you have an injection there is a potential for injury or trauma to nerves, blood vessels or soft tissue structures. The clinician uses ultrasound guidance and is trained to take all appropriate steps to minimise risks and avoid injecting or traumatising any soft tissue structures when performing the injection. However with particular injections at certain locations there will always remain a very small risk that this could occur. This will be discussed further at your appointment.

Can I take my regular medication when I have a Hyaluronic acid injection?

Yes, it is safe for you to take other medications alongside the hyaluronic acid injection. Hyaluronic is not an actual drug and is considered a medical device. Currently no known significant drug interactions occur with hyaluronic acid and other medications so is a suitable alternative if you cannot have other procedures or want to avoid any steroid injections.

As with any injection however, you still must tell the clinician performing the injection if you are taking an anti-coagulant (blood thinning) medication as they may need to discuss this with your GP before proceeding with the treatment.