Hyaluronic injections. Many patients I see have had prior discussion with doctors about hyaluronic acid injections. These injections can provide a good amount of pain relief, temporarily. Hyaluronic acid is a naturally occurring substance that is a major component of the protective synovial fluid that surrounds joints. In its natural form it is also a key component of wound healing. In its processed form used for injection purposes, hyaluronic acid is NOT a key healing component as attested to by suggestions and recommendations that these injections are stop gaps until knee replacement can be performed.
In March 2022 a research team (1) suggested that one injection of hyaluronic acid (Synvisc-One®) would be offers benefit to patients for up to one year. In this study while the researchers noted that intra-articular hyaluronic acid injections have been widely studied with variable and conflicting results fifty patients in their study saw “Short-term (up to one year) beneficial effects of intra-articular viscosupplementation with hyaluronic acid in early primary knee osteoarthritis (which) can be seen with a decreasing trend in the intensity of pain and an increasing trend in improving the physical functioning and health-related quality of life.”
A May 2022 paper (2) wrote: “The utilization of hyaluronic acid for the management of knee osteoarthritis remains controversial . . ” The purpose then of this study was to evaluate changes in overall utilization and health-care costs associated with hyaluronic acid injections among Medicare beneficiaries over a contemporary time frame.”
What the researchers found was that between 2012 to 2018 total hyaluronic acid injection increased significantly this despite the 2013 American Academy of Orthopaedic Surgeons clinical practice guideline recommending against the clinical utility of these injections, hyaluronic acid injections continued to be widely implemented among Medicare beneficiaries.
An October 2023 study (3) looked at possible long-term benefits of using a combination PRP and intra-articular hyaluronic acid protocol for knee osteoarthritis. In this study researchers produced a systematic review to examine the effectiveness and safety of combining hyaluronic acid and PRP therapy versus using PRP therapy alone. They suggest “Based on the most up-to-date evidence, the dual approach of PRP and hyaluronic acid therapy yields outcomes similar to PRP therapy alone in the short term, up to 12 months.” They also suggested that “when considering longer-term results, particularly in the 24-month follow-up, dual therapy holds the potential to produce superior outcomes compared to PRP alone therapy.”
An October 2023 study (4) looked to see if ultrasound-guided intra-articular hyaluronic acid hip injections were made more effective by including corticosteroids. In this research, doctors examined 167 patients hip osteoarthritis patients 12 months after receiving a hip injection of either a combination of medium-high molecular weight hyaluronic acid and corticosteroids (given to 76.2% of the study patients) or hyaluronic acid (23.8% of patients) alone. At 12 months after the treatment, the doctors notcied that a percentage of patients were using less anti-inflammatory medications, and had an overall reduction of instrumental physical therapies and therapeutic exercise. The researchers also recorded that that at one year, 22.6% of the study patients had moved onto hip replacement.
1 Acharya K, Si V, Madi S. Improvement in condition specific and generic quality of life outcomes in patients with knee osteoarthritis following single intraarticular viscosupplementation injection. Journal of Clinical Orthopaedics and Trauma. 2022 Apr 1;27:101828.
2 Zhu KY, Acuña AJ, Samuel LT, Grits D, Kamath AF. Hyaluronic Acid Injections for Knee Osteoarthritis: Has Utilization Among Medicare Beneficiaries Changed Between 2012 and 2018?. JBJS. 2022 May 18;104(10):e43.
3 Howlader MA, Almigdad A, Urmi JF, Ibrahim H. Efficacy and Safety of Hyaluronic Acid and Platelet-Rich Plasma Combination Therapy Versus Platelet-Rich Plasma Alone in Treating Knee Osteoarthritis: A Systematic Review. Cureus. 2023 Oct 18;15(10).
4 Ronconi G, Codazza S, Panunzio M, La Cagnina F, Ariani M, Gatto DM, Coraci D, Ferrara PE. The Effects of Ultrasound-Guided Intra-Articular Injections with Hyaluronic Acid and Corticosteroids in Patients with Hip Osteoarthritis: A Long-Term Real-World Analysis. Journal of Clinical Medicine. 2023 Oct 18;12(20):6600.