How Hyaluronic Injections May Help Hurting Joints
By: Edward G. Loniewski, DO, FACOS, FAOAO
Three Key Points about Hyaluronic Injections:
- Hyaluronic acid is a natural component of a healthy joint which degrades over time
- Replacing hyaluronic acid in a joint can help reduce pain and delay joint replacement in some patients
- Hyaluronic acid is sometimes covered by insurance programs
What are Hyaluronic Injections?
Hyaluronic acid is a normal, natural component of collagen in your body. It is also a natural component of the fluid in your joint called synovial fluid. As you age, your body slowly loses this vital component, and the result is a failure of these structures. An example of this would be seen in the loss of hyaluronic acid found in the skin on your face, which results in wrinkles. Loss of hyaluronic acid found in your eyes results in cataracts, and the loss of hyaluronic acid in your joint can lead to arthritis.
Hyaluronic acid is found in numerous components of your joints including the synovial fluid, the menisci, and the articular cartilage. When lost, trained medical professionals can now replace this hyaluronic acid with a substitute found most readily in the combs of roosters. 50% - 60% of patients can expect to see 6 - 12 months of pain relief as a result of the injection procedure.
How Do Hyaluronic Injections Work?
Patients are given a series of three or five injections into the joint approximately one week apart. The hyaluronic acid in these injections attaches to the lining of the joint called the synovium. The receptors of this lining are stimulated to produce more of your natural hyaluronic acid. This can increase the viscosity (thickness) of your joint fluid. This increase in viscosity helps the native cartilage cells metabolize and function like a healthier joint, and the result is a reduction in pain and an increase in overall function.
Who’s is The Ideal Candidate For Hyaluronic Injections?
Although not a complete list, the following is a general guideline to help you understand who may be an ideal candidate for this procedure. Prospective patients and their surgeons will always find exceptions as not every patient responds the same to each treatment. The ideal patient may consist of:
- Patients looking for midterm pain relief of 3 -12 months.
- No or limited instability symptoms to the joint (less than 2x per week)
- Able to return for five injections given one week apart
- Willing to participate in additional therapies to improve the health of the joint
Are Hyaluronic Injections Safe?
Hyaluronic injections have a good safety record; however, some patients with allergies to poultry or feathers may have swelling and pain with these injections. For this reason, it is important to make the staff at Cellular Healing aware of these allergies, as we can easily use a non-avian (non-bird) formula. Infections and persistent joint pain or swelling is extremely rare with these injections. A review of multiple studies using hyaluronic acid revealed that the only adverse effects of significance are transient local reactions in the injected joint observed at a rate of 2% to 4%.[1]
What is the efficacy of Hyaluronic Injection Treatment?
A double-blind placebo controlled study of 495 patients revealed 56% of patients receiving had pain relief for six months and improved function with less side effects (2% vs. 9%), as compared to Naprosyn (a common anti-inflammatory).[2] Another study by Wadell presented at the American Academy of Orthopedic Surgeons convention 2005 showed that they could delay the need for a knee replacement. They injected 11,187 patients, and over 75% of patients with severe arthritic changes had not undergone a knee replacement at 3.8 years.
How Convenient Is The Hyaluronic Injection Procedure?
There are three to five injections at approximately one week apart, meaning patients would come in to the office three to five times. The maximum effect of the injections normally peaks at three months; for this reason, patience is required in order to reach maximum treatment benefit. Upon completion of each injection, patients may safely drive themselves home, as there is no need for a secondary driver. Normally, patients are advised to rest for the first 24 hours after each injection.
Is The Hyaluronic Injection Procedure Painful?
Our staff will numb the patient’s skin with a cooling spray to reduce any topical pain. Occasionally, some patients will have pain during the injection, which may last for anywhere from 5 minutes to a day. Resting and icing the knee will help.
What is the cost of a Hyaluronic Injection procedure?
Most health insurance plans cover hyaluronic injections to the knee, but not any other joint (i.e. hips or ankles). Recently, there has been a trend where many insurance companies choose not to cover these injections; however, many plans, including Medicare, still cover them. Most insurance plans have deductibles, copays, coinsurance, and uncovered services. The average cost of a hyaluronic acid injection is approximately $200 each (five injections = $1,000; three = $600). These expenses may be reimbursable through qualified Health Spending Accounts (HSA), Flexible Spending Account (FSA), Medical Savings Account (MSA), or Health Reimbursement Arrangement (HRA). Please contact your plan administrator for details.
If you would like a face to face visit with Dr. Loniewski, please call 810-299-8552 for an appointment.
[1] Peyron, JG, Intraarticular hyaluronan injections in the treatment of osteoarthritis: state-of-the-art review, Journal of Rheumatology, 1993, Aug 39;10-5[2] Altman RD, Intraarticular sodium hyaluronate (Hyalgan) in the treatment of patients with osteoarthritis of the knee: a randomized clinical trial. Hyalgan Study Group. J Rheumatology. 1998 Nov; 25(11):2203-12