Hyaluronic Acid Injections

There are a number of hyaluronic acid injectable options on the market. We routinely use two options here at Clinic 360. At request we can obtain other brands.

• Ostenil Plus is the first, which is a lower molecular weight injection which has a relatively quick mode of action. It is well tolerated and has a very safe injection profile.
• Sinovial HL is the second; this is a combination of high- and low-molecular-weight hyaluronic acid which has a relatively quick mode of action and can provide longer pain-relieving effects in suitable patients.

Like any injection treatment, the specific diagnosis is important in understanding who is likely to respond favourably to this type of treatment.

• Severity of the osteoarthritis: hyaluronic acid injections of any type are more effective for individuals with mild to moderate arthrosis. In these patients some of the articular cartilage remains, allowing the injected hyaluronate to improve lubrication and reduce associated inflammation. In patients with severe arthrosis this treatment is less likely to give a sustained improvement, and surgery may actually be your best treatment option. However, in patients that are not fit for surgery or do not want to have a joint replacement, this treatment can still be administered under the patient’s understanding as part of their pain management strategy.
• Acute symptoms with a swollen joint. Hyaluronic acid is not typically effective at treating ‘flares of osteoarthritis’. Typically, this would be treated, where appropriate, with a steroid injection to relieve the acute symptoms of inflammation more quickly. Once these symptoms have settled, the patient can have a hyaluronic acid injection at a later date as part of a longer-term pain management plan. Steroid and hyaluronic acid injections can be administered concurrently on occasions, giving the immediate pain-relieving effects of the steroid and the sustained benefit of hyaluronic acid.
• Young and middle-aged, active patients are good candidates for hyaluronic acid injections. Typically, they have less severe osteoarthritis; the injections help with joint mobility and function, which is important to younger patients, not just ‘pain relief’. This type of injection also avoids the potential risk of any accelerated cartilage breakdown that may manifest with repeated steroid injections. Elderly patients can still benefit from this procedure, but expectations must be set initially, especially in the presence of substantial joint osteoarthritis.

Side effects are the unwanted but usually self-limiting/temporary effects of having a hyaluronic acid injection. Potential side effects include

• Increase pain and swelling in the joint or area known as a ‘post-injection flare’. This usually settles within a couple of days but can sometimes last longer.

Complications are more serious side effects that need immediate medical attention during or after the procedure. Serious complications are very rare but include:

• An infection within the joint or soft tissue surrounding it. If the pain in your joint suddenly gets worse and your joint feels hot, swollen and warm to the touch, accompanied by you feeling unwell, you should seek urgent medical advice, typically from AE. They happen in about 1 in 3,000 to 50,000 people.
• Pseudoseptic arthritis is also a very rare complication of hyaluronic acid injections. This presents as a very severe pain in the affected joint but without the systemic features of sepsis. This does usually resolve without treatment but given the severity of symptoms, a workup to exclude a true infection is typically required. This is very rare and typically seen with the higher-weight molecular injection options.

Typically, the side effects and complications of hyaluronic acid injections are less extensive than those of steroids, though serious complications in either are very rare. Hyaluronic acid injections have a very safe safety profile and benefit many hundreds of thousands of patients every year.