The Benefits and Considerations of Hyaluronic Acid Joint Injections

Joint pain affects millions of people in the UK, limiting mobility and reducing quality of life. For those living with conditions like osteoarthritis, finding effective and lasting relief can be a long, frustrating process. One treatment gaining increasing attention is hyaluronic acid joint injection therapy — a minimally invasive option that aims to restore normal joint function and reduce pain without the systemic risks associated with some long-term medications. This article explores how these injections work, who they can help, and what the clinical evidence says about their benefits.

What is hyaluronic acid and how does it work in joints?

Hyaluronic acid (HA) is a naturally occurring substance found throughout the body, but it plays a particularly important role in synovial fluid — the thick liquid that lubricates and cushions your joints. Acting as both a shock absorber and a lubricant, hyaluronic acid reduces friction between bone surfaces during movement and helps maintain the structural environment of the joint.

In people with osteoarthritis, the concentration and quality of hyaluronic acid in the synovial fluid decreases significantly. This deterioration leads to increased bone-on-bone contact, pain, stiffness, and inflammation. The cartilage itself may also begin to break down more rapidly without adequate lubrication.

Hyaluronic acid injections — also known as viscosupplementation — aim to restore this cushioning effect by delivering a purified or synthetic form of HA directly into the affected joint. Beyond simple lubrication, research suggests HA may also have anti-inflammatory properties and could play a role in protecting remaining cartilage. A 2022 review noted that intra-articular HA may modulate pain receptor sensitivity, which could help explain why some patients experience relief that extends beyond what joint lubrication alone would be expected to provide. [1]

By supplementing natural HA levels, viscosupplementation can:

• Improve joint lubrication and reduce friction

• Reduce pain and local inflammation

• Support cartilage health and slow further deterioration

• Restore range of movement and functional mobility

Who can benefit from hyaluronic acid joint injections?

Hyaluronic acid injections are most commonly used for patients with mild to moderate osteoarthritis, particularly in the knee — the joint for which the strongest clinical evidence exists. However, they are also used for hip, shoulder, ankle, and other joints where osteoarthritis has caused persistent pain and reduced function.

Patients who are most likely to benefit include those who:

• Have mild to moderate osteoarthritis without severe bone-on-bone degeneration

• Have persistent joint pain affecting daily activities such as walking, climbing stairs, or standing for extended periods

• Have stiffness and a reduced range of motion

• Cannot tolerate or have contraindications to oral pain medications such as NSAIDs

• Have had limited success with physiotherapy or other conservative treatments alone

• Are seeking to delay or avoid joint replacement surgery

Hyaluronic acid injections are also used for patients who have recently undergone arthroscopic joint surgery and are struggling with ongoing pain and stiffness during rehabilitation. In these cases, HA can support the joint environment while the patient works to regain function.

It is important to consult a qualified healthcare provider to determine whether viscosupplementation is appropriate for your specific condition and health status, as results vary depending on the stage of joint degeneration and individual factors.

What happens during the injection procedure?

The procedure is straightforward and typically takes less than 30 minutes. Here is what to expect:

1. The clinician cleans the skin over the affected joint to minimise infection risk.

2. A local anaesthetic may be applied to reduce discomfort during the injection.

3. Using a fine needle, the hyaluronic acid solution is injected directly into the joint space. In some cases, ultrasound guidance may be used to improve accuracy of needle placement.

4. If excess fluid is present in the joint, the clinician may drain it before administering the HA to reduce pressure and improve the effectiveness of the injection.

5. The patient is briefly monitored for any immediate reactions before being discharged.

Most patients experience only mild discomfort during and immediately after the procedure. No anaesthesia or extended recovery period is required.

The benefits of hyaluronic acid injections

Hyaluronic acid injections offer a range of benefits that make them a compelling option for patients who have not found adequate relief through physiotherapy or oral medication alone. While individual results vary, the treatment has a well-established profile across several key areas — from pain relief and improved mobility to longer-term considerations around joint health and surgical timing.

1. Effective pain relief with a favourable safety profile

One of the most significant benefits of hyaluronic acid injections is that they provide meaningful pain relief without the systemic side effects associated with long-term oral medication use. NSAIDs, for example, can cause gastrointestinal problems, cardiovascular risk, and kidney issues when taken regularly. Corticosteroid injections, while fast-acting, are associated with cartilage degradation, adrenal suppression, and bone density loss when used repeatedly.

Hyaluronic acid, by contrast, is a substance the body produces naturally. Injected directly into the joint, it works locally rather than throughout the whole body, significantly reducing the risk of systemic effects. Some patients also find that HA injections provide more sustained relief than corticosteroids, which often wear off within a few weeks.

2. Improved joint function and mobility

By restoring the lubricating properties of synovial fluid, hyaluronic acid injections can help joints move more freely and with less discomfort. Many patients report meaningful improvements in mobility — including the ability to walk longer distances, navigate stairs, and return to low-impact exercise — following a course of treatment.

This improvement in function can have a significant knock-on effect on overall wellbeing, particularly for older patients or those managing other health conditions alongside joint pain.

3. A potential chondroprotective effect

There is growing interest in the possibility that hyaluronic acid injections may do more than simply lubricate the joint. Some research suggests that HA may have a chondroprotective effect — helping to slow the breakdown of articular cartilage by reducing inflammatory processes within the joint environment. While further evidence is needed to fully establish this mechanism in clinical practice, it represents a potentially important distinction from treatments that purely manage pain without addressing the underlying joint environment. [2]

4. Delaying the need for joint replacement surgery

For patients who aren’t yet ready for joint replacement, or for whom surgery presents additional risk — for example due to age, weight, or other health conditions — hyaluronic acid injections can provide enough relief to postpone the need for operative intervention, sometimes by several years.

This delay can be highly significant. It allows patients more time to optimise their overall health before surgery, reduces the likelihood of needing revision surgery in younger patients, and avoids the risks and recovery demands associated with major joint replacement.

5. Supporting post-surgical rehabilitation

A less widely discussed but clinically important application is the use of hyaluronic acid injections following arthroscopic joint surgery. Patients who continue to experience pain or restricted mobility during the rehab phase may benefit from HA to support the joint environment, reduce residual inflammation, and facilitate more effective physiotherapy. In these cases, injections are typically used as part of a broader rehabilitation plan rather than as a standalone treatment.

6. Minimal recovery time and no requirement for admission

Because the procedure is minimally invasive, patients can usually resume most normal activities shortly after the injection. There is no surgical incision, no need for general anaesthesia, and no hospital admission required. Patients are typically advised to avoid strenuous activity or high-impact exercise for 24–48 hours, but most day-to-day activities can be resumed almost immediately.

Are hyaluronic acid injections better than steroid injections?

This is one of the most common questions patients ask when exploring injection therapy for joint pain, and the honest answer is: it depends on the clinical picture.

Corticosteroid (steroid) injections tend to act faster, often providing noticeable relief within days. They are typically the preferred option when there is significant acute inflammation or a joint effusion that needs to be addressed quickly.

Hyaluronic acid injections, on the other hand, tend to take longer to reach full effect — often several weeks — but may provide more sustained relief over a longer period. Research cited by the European Alliance for Associations of Rheumatology (EULAR), which maintains a positive recommendation for HA in knee osteoarthritis, supports the use of viscosupplementation in patients where steroids have provided only temporary relief or where repeated steroid use raises concerns. [3]

Crucially, hyaluronic acid doesn’t carry the same risks of cartilage damage and adrenal dysfunction that can accompany repeated steroid injections over time. For patients who need ongoing, long-term symptom management, this makes HA a more sustainable option for many.

The two treatments are not mutually exclusive — in some protocols, a course of HA follows an initial steroid injection to extend the overall duration of relief.

Potential risks and considerations of hyaluronic acid injections

Hyaluronic acid injections are generally well tolerated, but as with any injectable treatment, there are some risks to be aware of:

• Injection-site reactions: Mild swelling, warmth, or discomfort around the injection site is common in the first 24–72 hours and usually resolves without treatment.

• Injection flare: A small number of patients experience a temporary increase in joint pain and swelling following the injection — sometimes called a pseudoseptic reaction. This typically resolves within a few days but should be reviewed by a clinician if symptoms are severe. [4]

• Allergic reaction: Rare but possible, particularly with formulations derived from avian sources (rooster comb). Patients with known sensitivities should inform their clinician before treatment. Most modern HA formulations are produced synthetically or from bacterial fermentation, which substantially reduces this risk.

• Infection: Any injection carries a small risk of introducing infection into the joint. This risk is minimised through strict sterile technique and appropriate clinical setting.

• Varying response: Not all patients respond equally to HA injections. Patients with severe end-stage osteoarthritis, high BMI, or significant comorbidities may see less benefit. Your clinician should assess your suitability carefully before proceeding.

How long do the effects of hyaluronic acid injections last?

The duration of relief varies depending on the individual, the joint involved, and the severity of the underlying condition. Most patients can expect symptomatic improvement lasting from three to nine months, with some reporting benefit for up to a year following a full course of injections.

A single-injection formulation is available and may be suitable for certain patients, while others may receive a course of three injections spaced one week apart to maximise benefit. A 2022 study found that the majority of patients receiving a concentrated single-dose HA injection reported at least 50% improvement in pain, stiffness, and mobility at six months. [5]

Repeat courses can be administered when symptoms return, and evidence from a systematic review found that repeated HA injections were safe and continued to reduce pain over more than two years of ongoing treatment. [6]

Which joints can be treated with hyaluronic acid injections?

While the knee is the most extensively studied joint for viscosupplementation — and the joint for which the strongest evidence base exists — hyaluronic acid injections can be used in a range of other joints, including:

• Hip — used when patients have hip osteoarthritis and have not responded adequately to conservative care; typically performed under ultrasound or X-ray guidance due to the depth of the joint

• Shoulder — for glenohumeral osteoarthritis or rotator cuff-related joint degeneration

• Ankle — increasingly supported by evidence for ankle osteoarthritis, particularly where conservative management has failed

• Thumb and wrist — less common but used in patients with carpometacarpal or wrist joint arthritis

The use of ultrasound guidance significantly improves the accuracy of injection in these less accessible joints, helping to ensure the HA reaches the intended target within the joint space.

Complementary approaches to maximise results

Hyaluronic acid injections are most effective when used as part of a broader joint management plan rather than as a standalone intervention. Supporting strategies include:

• Physiotherapy: Strengthening the muscles around the affected joint reduces mechanical load, improves stability, and helps patients get more out of their injection treatment. Ideally, a structured physiotherapy programme should run alongside or follow on from injection therapy.

• Weight management: Reducing excess body weight decreases the compressive load through weight-bearing joints, particularly the knees and hips. Even modest reductions in weight can have a meaningful impact on pain levels and the effectiveness of treatment.

• Low-impact exercise: Activities such as swimming, cycling, or walking support joint health, maintain cartilage nutrition, and help to preserve mobility without placing excessive stress on arthritic joints. The NHS recommends staying active as a core component of managing osteoarthritis. [7]

• Pain management strategies: Heat, cold therapy, and topical treatments (such as diclofenac gel) can provide additional symptomatic relief between or alongside injection courses.

When should you seek urgent medical advice?

If you experience any of the following following a hyaluronic acid injection, contact your clinician promptly:

• Sudden or severe increase in joint pain or swelling

• Redness, warmth, or swelling spreading beyond the injection site

• Fever or general feeling of being unwell

• Symptoms that are getting worse rather than improving after 72 hours

These could indicate infection, an allergic reaction, or an injection flare requiring assessment and treatment.

Could hyaluronic acid injections change your quality of life?

If you are considering hyaluronic acid injections for joint pain and would like to explore whether they are right for you, our specialist Daniel Taylor (MSc Injection Therapy, Non-Medical Prescribing) at Elite Joint Solutions offers a thorough assessment before any treatment is recommended. Book your consultation now.

References

1. Hunt C, Provenzano DA, Eshraghi Y, Mittal N, Souza D, Buchheit T. Should intra-articular hyaluronic acid be used routinely for knee osteoarthritis pain? PM R. 2022 Jul;14(7):879-885. doi: 10.1002/pmrj.12740. Epub 2022 Feb 2. PMID: 34837674; PMCID: PMC9970143.

2. Bauer C, Niculescu-Morzsa E, Jeyakumar V, Kern D, Späth SS, Nehrer S. Chondroprotective effect of high-molecular-weight hyaluronic acid on osteoarthritic chondrocytes in a co-cultivation inflammation model with M1 macrophages. J Inflamm (Lond). 2016 Sep 13;13(1):31. doi: 10.1186/s12950-016-0139-y. PMID: 27625590; PMCID: PMC5020517.

3. Conrozier T, Raman R, Diraçoglu D, Montfort J, Bard H, Baron D, Goncalves B, Richette P, Migliore A, Chevalier X, Brittberg M, Henrotin Y. EUROVISCO Consensus Guidelines for the Use of Hyaluronic Acid Viscosupplementation in Knee Osteoarthritis Based on Patient Characteristics. Cartilage. 2025 Dec;16(4):438-452. doi: 10.1177/19476035241271970. Epub 2024 Nov 20. PMID: 39564753; PMCID: PMC11577334.

4. Aydın M, Arıkan M, Toğral G, Varış O, Aydın G. Viscosupplementation of the knee: Three cases of acute Pseudoseptic Arthritis with painful and irritating complications and a literature review. Eur J Rheumatol. 2017 Mar;4(1):59-62. doi: 10.5152/eurjrheum.2016.15075. Epub 2017 Mar 1. PMID: 28293455; PMCID: PMC5335889.

5. Chavda S, Rabbani SA, Wadhwa T. Role and Effectiveness of Intra-articular Injection of Hyaluronic Acid in the Treatment of Knee Osteoarthritis: A Systematic Review. Cureus. 2022 Apr 26;14(4):e24503. doi: 10.7759/cureus.24503. PMID: 35651409; PMCID: PMC9135165.

6. Altman R, Hackel J, Niazi F, Shaw P, Nicholls M. Efficacy and safety of repeated courses of hyaluronic acid injections for knee osteoarthritis: A systematic review. Semin Arthritis Rheum. 2018 Oct;48(2):168-175. doi: 10.1016/j.semarthrit.2018.01.009. Epub 2018 Jan 31. PMID: 29496227.

7. NHS. Living with Osteoarthritis. 20 March 2023.