Hyaluronic Acid Joint Injections

Our practice is now offering ultrasound guided Hyaluronic Acid injection therapy for osteoarthritis of the knee, ankle and foot. 

What is hyaluronic acid? 

Hyaluronic acid (also referred to as hyaluronan, or HA for short) is a naturally occurring component of all moveable joints in the body. It’s considered as a key molecule of synovial fluid and its main function in the joint is to provide lubrication in the joint which allows the joint to move smoothly by reducing friction as well as providing a protective cushion for weightbearing joints such as the knee. In addition to its lubricating properties, hyaluronic acid also aids the growth and development of cartilage and promotes the growth of new cells and tissues. Furthermore, hyaluronic acid plays an important role in reducing inflammation caused by injury and tissue degeneration.

As joints undergo overuse (e.g. sporting activities or repeated manual work) or simply aging; the hyaluronic acid starts to become thin, and it starts to lose its protective properties. 

Hyaluronic acid and osteoarthritis 

Under normal circumstances, there is a balance in the body between the breakdown of old hyaluronic acid and the production of new hyaluronic acid. However, in osteoarthritis, the balance is disturbed, and the breakdown is faster than new production. This allows the cartilage to wear which in turn causes pain, swelling and stiffness.

Do hyaluronic acid injections work for osteoarthritis? 

As with any intervention, the results of hyaluronic acid injections vary with each patient. Some will experience complete relief from their symptoms, while others gain partial relief and others no relief. There have been many scientific studies on the effectiveness of hyaluronic acid injections for relief of osteoarthritis. Some of the key findings are as follows: 

• Pain relief is not immediate and may only start after about 4 weeks after the initial injection. 

• The duration of relief varies but if effective it can last up to 6 months or more in some individuals. 
• Having additional injections can provide even longer relief of up to 3 years. In some cases, this could help postpone a total knee replacement surgery. 

 Who Can have Hyaluronic acid injections? 

Hyaluronic acid injections can be offered to anyone suffering from osteoarthritis, but it’s normally only offered when other more conservative measures haven’t worked.  

You won’t get hyaluronan injections if you have: 

• a bleeding or blood clotting disorder, such as haemophilia 
• certain allergies 
• an infection in your knee or in the skin around your knee. 

Who will perform the ultrasound guided injection? 

The clinician performing the injection is a qualified musculoskeletal professional with many years of experience. Additionally, he is also a qualified sonographer and with a university qualification in administering ultrasound guided injections.

How is the injection administered? 

At our practice, the injection is administered with a prefilled sterile syringe, and delivered directly into the involved joint. To ensure that all of the hyaluronic acid goes precisely into the joint, we use ultrasound guidance so that we can visualise the needle as it enters from the surface of the skin and makes its way into the joint cavity. We can also visualise the release of the injectate and take images for our records. 

Is ultrasound guidance important? 

Yes, it’s very important in our opinion. Using ultrasound means that we can see exactly where the needle travels once it enters the skin and carefully follow its path into the desired area whilst ensuring that blood vessels or nerve fibres are not accidentally hit on route. Once the target area is reached, the contents of the syringe can be delivered exactly where it needs to be with none wasted in the surrounding tissues. Although a “blind” injection (without ultrasound guidance) can have a good rate of success in experienced hands, nevertheless, the margin of error is considerably higher. 

What joints can be injected with hyaluronic acid? 

Although most joints in the body can be injected safely with hyaluronic acid, currently at this practice we are concentrating on knee joints, ankle joints and other joints of the foot. 

How many injections will I need? 

Depending on the joint you are having injected, and the condition of your joint, you may need between 1-3 injections.