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Side Effects of Intra-Articular Knee Hyaluronic Acid Injection

Hyaluronic acid (HA) injections can be injected into the knee joint for the treatment of symptoms associated with osteoarthritis.

G
Greg Rubin
Sports Medicine Physician · December 3, 2023 · 3 min read

Overview

Hyaluronic acid (HA) injections can be injected into the knee joint for the treatment of symptoms associated with osteoarthritis. Originally, hyaluronate injections were derived from rooster combs. However, due to avian allergies, most formularies are now manufactured and do not carry the allergy risk.

Symptoms

The manufactured HA can be formulated in low weight, intermediate, and high weight varieties. The injections are typically given as a one-time injection or a series over three to five weeks. Hyaluronic acid is found naturally in patient’s synovial fluid and has been found to aid in joint lubrication and has anti-inflammatory effects.

Causes and Risk Factors

The values of HA have been found to be decreased in patients with osteoarthritis due to increased HA clearing. The most common side effect after a HA injection is localized pain after the injection. However, more debilitating is the development of an effusion following a HA injection.

Treatment Options

Intra-articular effusions following HA injection can be seen within the first 24 to 72 hours. Studies have found that effusions following HA can occur in up to 5% of patients who receive repeat HA injections. These patients can have debilitating pain and the symptoms may mimic a septic arthropathy.

Recovery

However, the chance of developing a septic arthropathy from HA has been found to be low. A knee aspiration performed for the development of an effusion after a HA injection will typically show a highly inflammable synovial fluid. There are several hypotheses as to the etiology of an effusion after a HA injection.

When to See a Doctor

If you are experiencing symptoms that may be related to side effects of intra-articular knee hyaluronic acid injection, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.

*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*

KneeInjections
G
Greg Rubin
Sports Medicine Physician
Sports Medicine Review contributor

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