Gel Injection ( Hyaluronic Acid ) for Knee Osteoarthritis - Pain Relief: What You Need to Know About Effectiveness and Treatment Option
Knee osteoarthritis (OA) is a common yet debilitating condition that affects millions of people worldwide. Characterized by pain, stiffness, and reduced mobility, it occurs when the protective cartilage in the knee joint wears down over time. While OA poses significant challenges, advancements in medical science have introduced effective treatments to manage symptoms and improve quality of life. One such treatment is hyaluronic acid - Gel Injection in the Joint —a minimally invasive option gaining attention for its ability to restore joint function and alleviate pain.
What is Hyaluronic Acid?
Hyaluronic acid (HA) is a naturally occurring substance found in the synovial fluid of healthy joints. Think of it as your body’s “joint lubricant”: it cushions bones, reduces friction during movement, and helps absorb shock. In a healthy knee, HA maintains viscosity, ensuring smooth, pain-free motion. However, in osteoarthritis, the concentration and quality of HA diminish, leaving joints vulnerable to inflammation and wear.
How Hyaluronic Acid - Gel Works
Hyaluronic acid injections - Gel Injections involve introducing a gel-like substance into the knee joint to restore lubrication and improve shock absorption. This treatment helps to:
Viscosupplementation: HA injections restore the viscoelastic properties of synovial fluid, enhancing joint lubrication and reducing friction between cartilage surfaces. This improved lubrication helps maintain smooth joint movement and may slow down cartilage degradation.
Shock absorption: The viscoelastic nature of HA increases the joint's ability to absorb shock, protecting the knee from the impact of daily activities. This cushioning effect can help reduce pain and potentially slow the progression of osteoarthritis.
Reducing stiffness and anti-inflammatory properties: While not as potent as corticosteroids, HA does possess mild anti-inflammatory effects. It can help reduce the production of pro-inflammatory mediators in the joint, contributing to decreased pain and inflammation and hence decrease joint stiffness.
Long-term benefits: Unlike some other treatments, the effects of HA injections can last for several months, with some patients experiencing relief for up to 6 months or more. Repeated cycles of HA injections may provide cumulative benefits over time.
Overall Management of Knee Osteoarthritis
Before exploring advanced treatments like hyaluronic acid - Gel Injection, it’s important to adopt foundational strategies to support joint health.
Here are key steps to manage knee OA:
Weight Management: Excess weight strains knee joints. Losing even 5–10% of body weight can significantly reduce pain and slow cartilage breakdown.
Low-Impact Exercise: Activities like swimming, cycling, or walking strengthen muscles around the knee, improving stability and reducing pressure on the joint.
Physical Therapy: A tailored exercise plan from a physiotherapist can enhance flexibility, posture, and strength.
Pain Relief Medications: Over-the-counter NSAIDs (e.g., ibuprofen) or topical creams may provide short-term relief. Always consult your doctor before long-term use.
Effectivness of HA (Gel) in Knee Osteoarthritis
Comparable to Corticosteroids with Longer-Term Benefits: A randomized trial compared a single injection of HA to corticosteroid. Both treatments provided similar pain relief at 12 weeks. However, the benefits of HA persisted up to 26 weeks, whereas the corticosteroid's effects diminished over time.
Effective in Working-Age Adults: A study focusing on patients aged 18 to 65 with knee OA found that those receiving high molecular weight HA injections experienced significant improvements in pain relief and knee function over 52 weeks compared to those receiving usual care alone.
1. Symptomatic Relief and Functional Improvement
A 2020 meta-analysis found that intra-articular injection of high molecular weight HA improved both pain and function in people with knee osteoarthritis.
2. Potential to Delay Surgical Intervention
HA injections have been suggested to reduce the need for joint replacement surgery by providing symptomatic relief and improving joint function, potentially delaying the progression of osteoarthritis.
3. Combination Therapies
Innovative treatments combining HA with other therapeutic agents have shown promise. For example, diclofenac etalhyaluronate—a conjugate of HA and the nonsteroidal anti-inflammatory drug diclofenac—has been approved in Japan for knee OA treatment. This formulation aims to provide sustained anti-inflammatory effects alongside the lubricating properties of HA.
These studies underscore the potential of HA injections to alleviate pain, enhance joint function, and possibly delay the need for surgical intervention in knee OA patients. However, individual responses to treatment can vary, and it's essential for patients to consult with their healthcare providers to determine the most appropriate therapy for their specific condition.
Who should get them?
If you’ve been battling knee osteoarthritis and haven’t found relief through conservative approaches like weight loss, exercise, physical therapy, or nonsteroidal anti-inflammatory drugs (NSAIDs), your clinician might recommend hyaluronic acid (HA) injections—commonly referred to as "gel shots." These injections are particularly valuable when other treatments fail to alleviate pain and improve mobility.
HA injections work by replenishing the natural lubrication in your knee joint, which is often depleted due to osteoarthritis. This helps reduce pain, improve joint function, and may even slow the progression of cartilage damage. Unlike NSAIDs, which can have side effects and aren't suitable for long-term use.
Improved Accuracy and Outcomes with Ultrasound Guided Injections
Ultrasound guidance significantly enhances the precision of HA injections, with studies showing 98-100% accuracy compared to only 55% accuracy with landmark-guided injections. This increased accuracy leads to:
Better pain relief and functional improvements
Reduced post-injection complications
Less painful injection experience for patients
Conclusion:
Hyaluronic acid (HA) is a gel like substance that helps cushion and lubricate the knee joint. In healthy knees, HA is naturally found in the synovial fluid, which acts as a shock absorber and helps the joint move smoothly.
When you have osteoarthritis, the natural HA in your knee breaks down, leading to stiffness, pain, and reduced mobility. HA injections (also called "gel shots" or "knee gel injections") add more of this cushioning fluid back into the joint. This can help:
✔ Reduce pain by improving joint lubrication
✔ Improve movement and flexibility
✔ Slow down the progression of arthritis in some cases
Many people with HA - Gel injection experience pain relief that lasts for several months. The effects depend on the type of HA used, the severity of arthritis, and individual response to treatment.
References:
Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019;27(11):1578-1589.
Highlights HA therapy as a recommended option in OA management guidelines.
Messier SP, Resnik AE, Beavers DP, et al. Intentional Weight Loss in Overweight and Obese Patients With Knee Osteoarthritis: Is More Better? Arthritis Care Res (Hoboken). 2018;70(11):1569-1575.
Evidence for weight management reducing OA symptoms.
American College of Rheumatology. 2021 American College of Rheumatology Guideline for the Treatment of Osteoarthritis. Arthritis Care Res (Hoboken). 2021;73(9):1241-1255.
Recommends exercise and physical therapy as core OA management strategies.
Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet. 2019;393(10182):1745-1759.
Comprehensive review of OA pathophysiology and treatments.
Bowman S, Awad ME, Hamrick MW, et al. Recent advances in hyaluronic acid based therapy for osteoarthritis. Clin Transl Med. 2018;7(1):6.
Explains HA’s mechanism of action and clinical benefits.