Hyaluronic acid knee

What is hyaluronic acid?

As a natural compound, hyaluronic acid can be found in connective tissue throughout the body and has water-binding properties. Particularly in joints, it performs an important task for patients and physicians. Synovial fluid (joint lubricant) is very rich in hyaluronic acid and ensures frictionless motion that protects the cartilage. Moreover, synovial fluid is essential for nutrition of the articular cartilage.

For about 30 years, synthetic hyaluronic acid has been applied to treat joints affected by osteoarthritis.

For which knee problems is hyaluronic acid effective?

In particular patients with gonarthrosis (osteoarthritis of the knee joint), therapy with hyaluronic acid has been commonly used for a number of decades. Especially in cases where osteoarthritis is less advanced and there is still sufficient articular cartilage present, doctors expect this substance to be very effective. For one thing, the remaining articular cartilage is thought to receive more nutrients and to be protected more, but also the synovial membrane is stimulated to produce more joint lubricant. It is thought to improve pain and stop or slow down joint degeneration.

Patients who are unable to tolerate the common painkillers of the NSAID class (ibuprofen, diclofenac) because of secondary diseases or allergies, or in case these drugs are not sufficient, hyaluronic acid therapy might also help. To effectively treat the typical inflammatory attacks of activated osteoarthritis, it is recommended by experts to use injections with a combination of cortisone and hyaluronic acid.

Hyaluronic acid injection or capsules

Normally, specialists directly inject hyaluronic acid into the affected joint of the patient. Once inside the joint cavity, hyaluronic acid immediately takes effect and reduces friction in the joint. This is also intended to build up a sort of protective coating to prevent further wear and tear on the cartilage.

Hyaluronic acid can also be prescribed as a food supplement and taken in the form of capsules. As the substance is absorbed by the body, it accumulates in the blood and subsequently in the connective tissue.

Research shows conflicting results regarding efficacy. Compared to painkillers (NSAIDs), injections show a slight advantage regarding their pain-relieving effects. Complications are very rare and include infections caused by the needle. In 1 out of 12 cases small, local and harmless bleedings occur at the puncture site. However, analgesic and anti-osteoarthritic effects by taking capsules have not been clearly demonstrated. Adverse effects or allergic reactions in association with capsules occur very rarely.

Which other joints can be treated with hyaluronic acid?

All joints affected by osteoarthritis can generally be managed with hyaluronic acid. Most frequently, patients complain ab from osteoarthritis of the knee and hip joints. These are the joints which are subjected to extraordinary loads. Hence, physicians have the most experience with the treatment. Joints that are easily accessible, like the knee joint, do not call for special imaging during therapy. Less accessible joints (such as the shoulder joint) or joints that lie deeper (such as spinal joints) require additional imaging studies to ensure accurate injection of the hyaluronic acid into the joint space. This involves the use of ultrasound or an X-ray, for example.

What are the costs of hyaluronic acid injection treatment by an orthopedist?

Overall cost of treatment by an experienced specialist is estimated to be around 250-350 euros. One injection is up to 42 euros, excluding the cost of the product. Most patients require 2-5 injections, which are given over a period of several weeks. This treatment with hyaluronic acid is not reimbursed by public health insurances and is part of the so-called "IgeL" services. Privately insured patients should discuss beforehand whether the costs will be covered by their insurance company.

Alternatives to hyaluronic acid injections

As an alternative, the pain medication regimen is usually adjusted. Some other alternatives include cortisone injections or platelet rich plasma (PRP) therapy.

PRP injection represents a very novel and little researched procedure involving the injection of a patient's own platelets (thrombocytes) into the affected joint. There are no long-term results yet. Nevertheless, positive effects regarding pain relief have been shown in initial trials.

Acupuncture, an alternative treatment method, involves the placement of fine needles into the skin (but not into the affected joint), which can improve the pain.

Experience and critique regarding hyaluronic acid injections in orthopedics

Hyaluronic acid injections have been performed for several decades now, and physicians frequently use this treatment. Despite this, researchers have expressed doubts as to whether the promised effects actually occur. They claim that the positive results are mainly due to the placebo effect. Neither can a treatment of the cause as well as a joint-preserving effect in terms of stopping joint degeneration be proven with certainty. Short-term hyaluronic acid treatment can thus be considered a symptomatic treatment. This is why the therapy is not covered by public health insurances, but rather available as a private supplementary service ("IGeL").

However, there is consensus among experts that hyaluronic acid injection therapy is advisable for certain groups of patients. If these patients are not able to receive the usual pain medication, or if their pain medication is no longer sufficient for copeing with daily life without pain, they are recommended to have a hyaluronic acid injection.

Which doctors and clinics specialize in the field of hyaluronic acid treatment of the knee?

If you're in need of a doctor, you expect the best medical care possible. So of course patients are curious to find out what clinic to go to. As there is no objective way to answer this question and a legitimate doctor would never claim to be the best, patients must rely on a doctor's experience.

Let us help you find an expert for your condition. All listed doctors and clinics have been reviewed by us for their outstanding specialization in the field of hyaluronic acid treatment of the knee and are looking forward to your inquiry or wish for treatment.