Hyaluronic acid (HA) injections offer relief from the pain of osteoarthritic joints. These improvements, though, are typically temporary and may last up to a year. While HA injections are generally safe, occasional side effects may occur following treatment. Please read the following information.
Understanding Hyaluronic Acid injections and their use
Hyaluronic acid naturally exists in the body, but the HA used in injections is a synthetic version. These injections are sometimes recommended for individuals with osteoarthritic conditions, which can cause joint pain. Various types of HA injections are available.
At Gecko clinic, we use Monovisc (HA) and Cingal (HA with triamcinolone hexacetonide). Some patients may require a series of injections, while others may receive a single injection.
MONOVISC® has the strongest clinical data of any pure Hyaluronic Acid in the world.
- Highest concentration – 88mg or 22mg/ml. High HA dose creates a high viscosity environment to replicate healthy joint function, lubricating cartilage surfaces, allowing the joint to glide smoothly and providing long-term pain relief for at least 6 months
- Optimised molecular weight which allows for a longer therapeutic effect
- Lightly cross-linked which leads to optimised joint residence time¹
- Ultra pure, non-avian service. Trusted fermentation technique with only 2% rate of mild injection reaction reported²
CINGAL® is a next generation osteoarthritis pain management treatment: fast acting, long lasting, non-opioid, and backed by robust clinical data. Cingal works within the first week following the injection, for some within 48hrs. Cingal is the only option to give this rapid pain relief similar to a pure steroid, but that then continues through to 6 months, as determined by the strongest level of human clinical trials². The formulation gives an anti-inflammatory and joint protective effect. Even though there is a steroid to Cingal, the concern of unwanted side effects is greatly diminished.²
Managing inflammation fast clears the path for stronger action of HA. This also helps your active lifestyle to resume quicker and any physiotherapy to accompany the injection to start at a higher level.
The injection process
Typically, the injection is administered directly into the painful joint. Most injections are quick and straightforward using ultrasound guidance. Ultrasound helps to deliver injection accurately and precisely to the painful joint. All our injections are performed using antiseptic non touch technique.
Prior to any injection treatment you will be thoroughly assessed and pre-screened for by one of our advance practice Physiotherapists specialising in ultrasound guided injections. Please note that following the assessment the injection therapy may also be deemed unsuitable.
After the injection
It is important that you follow your practitioner’s aftercare advice.
We recommend that you keep the area covered, clean and dry for 24 hours post injection. Strenuous exercise is not advised for 2-5 days post injection (depending on the area). There may be some post injection pain, swelling and inflammation at the injection site, rest and application of cold packs to the treated area can help and usually help to resolve the discomfort in couple of days. If you experience any ongoing pain or worsening of the symptoms, please contact us.
If the symptoms worsen during our non operating hours contact 111.
It takes typically 3-4 weeks for HA effects to become fully noticeable. Cingal contains a small dose of potent anti-inflammatory and it provides quicker pain relief.
Possibility of Future Injections
If you find HA injections helpful and other treatments haven’t worked, you may receive repeat injections. There is currently no evidence suggesting long-term harm from repeated HA injections.
Potential Risks and Side Effects
Most people experience HA injections without side effects. However, around 20-30% may experience some pain for a day or two (post-injection flare), which usually resolves quickly. A smaller proportion may have more significant pain lasting up to a week. Rarely, severe pain and swelling (pseudo-sepsis) can occur, requiring medical review. While the injections can be uncomfortable, severe pain is uncommon.
Infection
Infection is extremely rare (approximately 1:50,000 injections) but requires immediate medical attention if symptoms such as increased pain, heat, swelling, nausea, or feeling unwell occur. Inform healthcare professional of your recent HA injection. The injection site should be kept clean and dry for 24 hours post-injection.
Anaphylaxis
Allergic reactions to hyaluronic acid are exceptionally rare (1:500,000). Immediate medical attention is necessary if you experience symptoms like dizziness, difficulty breathing, a fast heartbeat, or loss of consciousness.
Other Side Effects
There are very few reported side effects associated with hyaluronic acid use.
Summary of Risks/Side Effects
Serious side effects are rare and may include joint and soft tissue infections, anaphylaxis (allergic reaction), and very rarely, severe pain and swelling (pseudo-sepsis). Other potential side effects include post-injection flare, which usually resolves within a few days.
Your therapist takes precautions to minimise risks, but there is a small chance of injury to soft tissues, nerves, or vessels.
Taking Other Medications
You can take other medications alongside hyaluronic acid injections, as there are no known significant drug interactions.
Corticosteroids may interfere with medications taken to treat diabetes and hypertension. Blood thinners (such as warfarin) will increase the risk of bleeding following an injection and the risks will be discussed during your consultation.
Pregnancy and Breastfeeding
Hyaluronic acid injections during pregnancy require specific consent from your GP. While there are no known risks during breastfeeding, it’s advisable to consult your GP.
Cost for Hyaluronic Acid Injections:
£350 Monovisc
£400 Cingal
We advise patients remain in the clinic for 20 minutes after the injection for observation of possible adverse reactions.
References:
1. Petterson SC, Plancher KD. Knee Surg Sports Traumatol Arthrosc (2018). https://doi.org/ 10.1007/s00167-018-5114-0 10.1177/1947603517703732.
2. Hangody L, Szody R, Lukasik P, et al. Cartilage 2017 May; doi: 10.1177/1947603517703732.
