Hyaluronic Injection Information

Many patients are being recommended hyaluronic acid injections as a potential alternative to steroid as they are potentially less harmful to the soft tissues in certain conditions and can give pain relief for longer duration therefore requiring less frequent injections. They are rarely offered on the NHS, but this is primarily based on cost and not because they are ineffective. Many patients prefer Hyaluronic Acid injections over steroid for a range of reasons.

Hyaluronic Acid (HA) injections can give many patients some relief of pain for degenerative joint conditions. The improvements, as with any injection, are temporary but can last up to 9 months. HA injections are generally considered to be very safe, although a few people may experience some minor side effects outlined below. The information below should be helpful in deciding if this a treatment option for you.

Hyaluronic acid is a naturally occurring substance within the body which can now be synthesised and can sometimes be used for treatment by injection into degenerative joints that have become painful and stiff. Many people like to think of HA as a "lubricant" injection, but it is a little more advanced than only that. 

HA injections are often suggested as a safe treatment for people with degenerative changes such as osteoarthritic, which may cause pain. There are different hyaluronic acid injections available with a range of lubricant quality and costs. Some patients may benefit from having a series of injections whereas some injections can be delivered as a single treatment. Tony and Keith can discussed this range of options with you and help you to decide which is the most appropriate for your specific circumstances.

The injection  will inject the HA directly into the area of your pain, typically a joint such as your knee. Your treating clinician will explain the procedure in more detail on the day based upon examination findings to help choose the most comfortable and effective treatment. Most HA injections are surprisingly quick and comfortable to perform. You can request also a local anaesthetic to the area to make the injection more comfortable.

We perform all of our injections under ultrasound guidance. This helps to localise the source of the pain, target the treatment to be delivered to the most appropriate and effective area. Ultrasound guidance also usually makes the injection more comfortable and reduces risk of unwanted side affects.

If you choose to have a local anaesthetic your pain may be significantly relieved within minutes, but unfortunately this effect will wear off after a couple of hours. Also, you might wish to consider arrangements for transport home after your injection as local anaesthetic may cause some numbness and make it difficult to drive.

You should usually allow a week or two for the effect of the HA to begin.  When having an injection into a joint, recommend that you might avoid strenuous exercise for three days afterwards due to possibility of some  post-injection discomfort. When having an injection around a tendon, your treating clinician may be advise you to avoid heavy impact and loading activities for a few days, again, this is due to potential discomfort following the injection.

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To be safe, we usually recommend that patients remain at the clinic for around 20 minutes following the injection to allow observation for any possible adverse reactions and so that they feel happy to make their journey home.

One of the very positive benefits of hyaluronic acid injections is that they can safely be repeated where patients find them to be helpful. Where other treatments have been unsuitable or may not have  helped, HA can provide a viable option or as an adjunct to ongoing treatments such as exercise. There is currently no research evidence to suggest any significant long term harm from having repeat injections of HA.

The vast majority of people can have HA injections without any significant side effects. A proportion of people, approximately 1 in 5, may have some pain for around 48 hours after the injections.  This will usually fully resolve quickly and can be managed with relative rest, cold compress and over-the-counter painkillers.

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There are very few other side effects that have been linked with the use of hyaluronic acid and they are generally regarded as a very safe procedure.

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BELOW IS A SUMMARY OF THE KNOWN RISKS/SIDE EFFECTS FROM HAVING HYALURONIC ACID INJECTION 
Serious side effects are extremely rare but can include:

• Joint and soft tissue infections – please see above

• Anaphylaxis (allergic reaction) – extremely rare
   

OTHER POTENTIAL SIDE EFFECTS MAY INCLUDE:

• Post-injection flare of pain at injection site – please see above
• Injury or trauma to neuro-vascular or soft tissue structures during the injection procedure  - your therapist is trained to take all appropriate steps to minimise risks and avoid injecting or traumatising any soft tissue structures, nerves or vessels when performing the injection. However, there will  always remain a very small risk that this could occur, particularly with injections at certain locations, this can also be discussed further at your appointment.

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You will be asked to remain in the clinic for up to twenty minutes following your injection to allow observation for possible adverse reactions from your injection.

Extremely rarely (around 1:50,000 according to the literature) patient may get an infection to the area shortly after an injection procedure. Your clinician will advise you about this again on the day. Should the joint suddenly become more painful, hot and swollen, in the days following your injection you should seek medical attention immediately, especially if you are feeling generally unwell.

Yes, it is safe for you can take other medications alongside the hyaluronic acid injection. There are currently no known significant drug interactions that occur with hyaluronic acid and other medications.

However, it is important to note that if you are taking a blood- thinning drug, such as Warfarin, you may need a blood test (test for INR) to make sure that your blood is not too thin to safely have the injection. The reason for this is due to the risk of bleeding into the joint at the time of the injection which may raise the risk of infection. Therefore you must tell the clinician performing the injection, if you are taking an anti-coagulant (blood thinning) medication as they may need to discuss this with your GP before proceeding with the treatment.

Unfortunately, we are not able to offer HA injections to patients who are pregnant. There are currently no known associated risks to having HA injections whilst breastfeeding, although we recommend that patients first discuss with their GP.