Arthritis Osteoarthritis Treatment Hyaluronan Injections for Knee Osteoarthritis 10 Things You Should Know About Hyaluronan By Carol Eustice twitter linkedin Carol Eustice is a writer who covers arthritis and chronic illness. She is the author of "The Everything Health Guide to Arthritis." Learn about our editorial process Carol Eustice Medically reviewed by Medically reviewed by Rochelle Collins, DO on April 03, 2020 linkedin Rochelle Collins, DO, is board-certified in family medicine. She is an assistant clinical professor of family medicine at Quinnipiac University and works in private practice in Hartford, Connecticut. Learn about our Medical Review Board Rochelle Collins, DO on April 03, 2020 Print PhotoAlto/Michele Constantini/Getty Images Hyaluronic Acid injections, also known as hyaluronan injections, are among the treatment options for osteoarthritis of the knee. The treatment, which is described as viscosupplementation, is aimed at improving lubrication of the knee, reducing pain and improving range of motion. The injections are given by a doctor in the office or clinic, and one or both knees can be injected at the same time. Here are 10 things you should know about hyaluronan injections. 1) Hyaluronan Is Usually Not a First-Line Treatment for Knee Osteoarthritis Your doctor may recommend that you consider a hyaluronan injection if you have not had adequate pain relief from more conservative treatment options, including: MedicationsExercise/physical TherapyWeight loss if you are overweightHeat and coldUse of an assistive mobility device, such as a cane 2) There Is Controversy About How Well Hyaluronan Injections Work Clinical studies have suggested that hyaluronan injections can decrease pain and improve function in people who have with mild to moderate osteoarthritis of the knee. Critics suggest that the studies were flawed, and most doctors believe there is no definitive answer to whether hyaluronan injections are more effective than corticosteroid injections or oral medications. It is clear that the injections are not a cure, and there is no evidence that suggests hyaluronan injections affect the underlying disease course. 3) The Effects of Treatment Are Variable Although hyaluronan injections are not usually recommended before trying other treatment options, the best results usually occur in the early stages of osteoarthritis. If you are in the later stages of the disease or waiting for knee replacement surgery, you may be considered a good candidate for hyaluronan injections, which can provide some relief while you are waiting for your surgery. The most significant pain relief from knee osteoarthritis is seen between 8 and 12 weeks after the first injection, and pain relief can last up to six months, with some people getting relief for an even longer duration. If your improvement starts to wane, you may be able to repeat your course of treatment with additional hyaluronan injections. 4) There Are Several Different Brand Options The U.S. Food and Drug Administration (FDA) has approved the following brands of hyaluronan injections: HyalganDurolaneNuflexxaSynviscSupartz and Supartz FXGel-OneZilrettaOrthoviscMonoviscEuflexxa 5) The Treatment Course Varies Depending on the Type of Injection The different hyaluronan brands are formulated a little differently, and some act faster, while others last longer. Synvisc-One requires one injection. A complete course of treatment with Synvisc, Orthovisc, or Euflexxa requires three separate knee injections given one week apart. Both Hyalgan and Supartz require five separate injections given one week apart. 6) Hyaluronan Injections Are Not Approved for Other Types of Osteoarthritis Hyaluronan injections are approved for several other conditions, including burns and ulcers. As an injected treatment for osteoarthritis, it is only FDA-approved for osteoarthritis of the knee, not for other regions of the body. Its use for shoulder, hip, and ankle osteoarthritis is being studied. 7) Consider Safety Factors Before Getting an Injection Hyaluronan injections are not considered safe for children, pregnant women, or nursing mothers. If you are allergic to bird products (i.e., feathers, eggs or poultry) you should talk to their doctor, as the product is extracted from rooster combs. 8) You Do Not Need to Stop Your Other Medications There should be no adverse interaction with other pain or anti-inflammatory medications that you may be taking, so you do not need to stop taking them if you will have an injection. 9) Avoid Strenuous Activities for 48 Hours You can reduce the chances of experiencing side effects if you rest your knee for the first few days right after your injection. The most common side effects occur around the injected joint are usually mild and include: Temporary injection site painSwellingRedness and warmthItchingBruising 10) Medicare and Private Insurance Reimbursement Currently, Medicare will cover hyaluronan injections for the knee only. Medicare also requires X-ray evidence of the knee osteoarthritis. Medicare will only cover hyaluronan injections if given no more frequently than every six months. Private insurance may have different rules, so it is always best to check. Always check for Medicare updates, too. A Word From Verywell The ends of the two bones in a normal joint are covered with cartilage and lubricated with synovial fluid, allowing the bones to glide over one another. Osteoarthritis is a degenerative disease in which the cartilage wears away, and the synovial fluid changes, losing its ability to lubricate the joint. Pain, stiffness, and limited range of motion result, and the condition continues to worsen. Treatment, such as therapy, pain medications, and injections, is directed at reducing pain. It is important to consider all of your options as you cope with osteoarthritis. Was this page helpful? Thanks for your feedback! Learn tips for managing arthrits pain, medications, and daily challenges. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Guo Y, Yang P, Liu L. Origin and Efficacy of Hyaluronan Injections in Knee Osteoarthritis: Randomized, Double-Blind Trial. Med Sci Monit. 2018;24:4728–4737. Published 2018 Jul 9. doi:10.12659/MSM.908797 Bhadra AK, Altman R, Dasa V, et al. Appropriate Use Criteria for Hyaluronic Acid in the Treatment of Knee Osteoarthritis in the United States. Cartilage. 2017;8(3):234–254. doi:10.1177/1947603516662503 Allen C, Sheehan R, Deyle G, Wilken J, Gill N. A manual physical therapy intervention for symptoms of knee osteoarthritis and associated fall risk: A case series of four patients. Physiother Theory Pract. 2019;35(4):392-400. Goldberg VM, Goldberg L. Intra-articular hyaluronans: the treatment of knee pain in osteoarthritis. J Pain Res. 2010;3:51–56. Published 2010 May 10. doi:10.2147/jpr.s4733 Askari A, Gholami T, NaghiZadeh MM, Farjam M, Kouhpayeh SA, Shahabfard Z. Hyaluronic acid compared with corticosteroid injections for the treatment of osteoarthritis of the knee: a randomized control trail. Springerplus. 2016;5:442. Published 2016 Apr 12. doi:10.1186/s40064-016-2020-0 Bowman S, Awad ME, Hamrick MW, Hunter M, Fulzele S. Recent advances in hyaluronic acid based therapy for osteoarthritis. Clin Transl Med. 2018;7(1):6. Published 2018 Feb 16. doi:10.1186/s40169-017-0180-3 Bronstone A, Neary JT, Lambert TH, Dasa V. Supartz (Sodium Hyaluronate) for the Treatment of Knee Osteoarthritis: A Review of Efficacy and Safety. Clin Med Insights Arthritis Musculoskelet Disord. 2019;12:1179544119835221. Published 2019 Apr 12. doi:10.1177/1179544119835221 Dasa V, DeKoven M, Sun K, Scott A, Lim S. Clinical and cost outcomes from different hyaluronic acid treatments in patients with knee osteoarthritis: evidence from a US health plan claims database. Drugs Context. 2016;5:212296. Published 2016 Jun 23. doi:10.7573/dic.212296 Yoshioka K, Katayama M, Nishiyama T, Harada K, Takeshita S, Kawamata Y. Biocompatibility study of different hyaluronan products for intra-articular treatment of knee osteoarthritis. BMC Musculoskelet Disord. 2019;20(1):424. Altman RD, Akermark C, Beaulieu AD, Schnitzer T. Efficacy and safety of a single intra-articular injection of non-animal stabilized hyaluronic acid (NASHA) in patients with osteoarthritis of the knee. Osteoarthr Cartil. 2004;12(8):642-9. Euppayo T, Punyapornwithaya V, Chomdej S, Ongchai S, Nganvongpanit K. Effects of hyaluronic acid combined with anti-inflammatory drugs compared with hyaluronic acid alone, in clinical trials and experiments in osteoarthritis: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2017;18(1):387. Published 2017 Sep 6. doi:10.1186/s12891-017-1743-6 Walker K, Basehore BM, Zito PM. Hyaluronic Acid. [Updated 2019 Oct 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482440/ Bowens, Amanda. Hyaluronic Acid injections for osteoarthritis of the knee. ACC. New Zealand. September 2016. Sen R, Hurley JA. Osteoarthritis. [Updated 2019 Feb 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482326/ Additional Reading Kaulback K, Jones S, Wells C, Felipe E. Viscosupplementation for Knee Osteoarthritis: A Review of Clinical and Cost-Effectiveness and Guidelines [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2017 Jun. CADTH Rapid Response Reports. Wang SZ, Wu DY, Chang Q, Guo YD, Wang C, Fan WM. Intra-articular, single-shot co-injection of hyaluronic acid and corticosteroids in knee osteoarthritis: A randomized controlled trial. Exp Ther Med. 2018 Sep;16(3):1928-1934. doi: 10.3892/etm.2018.6371. Epub 2018 Jun 29.