Hyaluronic Acid (Viscosupplementation)

How it works

Hyaluronic acid is a normal component of synovial fluid that contributes to its viscoelastic and lubricating properties; supplementation is proposed to improve joint lubrication and shock absorption.

Prescribing in practice

• Injections must be performed under aseptic technique by a trained clinician to avoid introducing septic arthritis.
• Transient post-injection pain and joint swelling can occur and usually settle spontaneously.
• Evidence of benefit is modest and guideline support is limited, so it is not routinely recommended for all patients.

Monitoring

Monitor the injected joint for an acute inflammatory or infective reaction and review symptomatic response at follow-up.

Counselling the patient

• You may have temporary pain or swelling in the joint after the injection.
• Seek urgent advice if the joint becomes hot, very painful or you feel feverish.
• Benefit varies between individuals and may be limited.

Evidence & guidelines

Evidence for intra-articular hyaluronic acid in knee osteoarthritis is mixed, and major guidance does not endorse its routine use.