Hyaluronic Acid for Osteoarthritis: What You Need to Know
Published on 2026-05-21
Hyaluronic Acid: Everything You Need to Know About Joint Viscosupplementation
Hyaluronic acid is a molecule naturally present in the synovial fluid of joints. In osteoarthritis, its concentration and quality decrease, reducing lubrication and joint shock absorption capacity. The injection of hyaluronic acid, called viscosupplementation, aims to restore these properties. But what can you really expect from it?
How Does It Work?
Hyaluronic acid injected into the joint temporarily replaces the deficient synovial fluid. Its mechanisms of action are multiple:
- Lubrication: restores smooth joint gliding
- Shock absorption: absorbs impact and protects cartilage
- Anti-inflammatory: reduces production of pro-inflammatory cytokines
- Analgesic: decreases transmission of pain signals
- Chondroprotective: potentially slows cartilage degradation
Which Joints Can Be Treated?
- Knee: most common, strongest clinical evidence
- Hip: effective, requires ultrasound guidance
- Shoulder: for glenohumeral osteoarthritis
- Ankle: encouraging results
- Thumb (CMC joint): injection under ultrasound guidance
- Spine (facet joints): more recent use
Expected Results
Results vary depending on the stage of osteoarthritis, the joint treated, and the quality of hyaluronic acid used:
- Onset of action: 1 to 3 weeks (progressive effect)
- Peak efficacy: 4 to 8 weeks after the injection series
- Duration of effect: 6 to 12 months on average
- Best results in moderate osteoarthritis (Kellgren-Lawrence grade 2-3)
- Less effective in advanced stages with significant cartilage loss
Regular physical activity and muscle strengthening complement the treatment and improve long-term outcomes. A repeat injection series can be performed annually if symptoms return.
Frequently Asked Questions
Is hyaluronic acid more effective than cortisone for osteoarthritis?
The two treatments have different indications. Cortisone works quickly (48-72 hours) but its effect is shorter (4-12 weeks). Hyaluronic acid works more gradually (2-4 weeks) but lasts longer (6-12 months). For chronic osteoarthritis, HA is often preferred. For acute flares, cortisone is more suitable.
How many hyaluronic acid injections can I have per year?
The standard protocol is 1 to 3 injections per year (as a series). This cycle can be repeated annually if results are satisfactory. There is no absolute limit, unlike cortisone.
Is the hyaluronic acid injection painful?
The injection itself causes moderate discomfort. After the injection, a local inflammatory flare (pain, swelling, warmth) may occur for 24 to 72 hours. This reaction is normal and resolves spontaneously.
Can hyaluronic acid rebuild cartilage?
No, hyaluronic acid does not regenerate lost cartilage. It improves synovial fluid quality, reduces pain, and may slow osteoarthritis progression. For cartilage regeneration, other approaches such as PRP or stem cells are being studied.
What are the risks of hyaluronic acid injection?
Risks are low: local inflammatory reaction (1-5% of cases), infection (< 0.1%), allergic reaction. The precision of ultrasound guidance minimizes these risks by ensuring correct intra-articular injection and avoiding vascular structures.