Hyaluronate Injections

For many years we have injected joints with cortisone. Now there has been a new breakthrough in the treatment of knee osteoarthritis with a new substance. Instead of cortisone, it is a naturally occurring substance that is normally found in high concentration in a knee joint. This substance is known as Hyaluronate.

Unfortunately with wear and tear problems in the knee the levels of this substance drops as the knee becomes more damaged. To counteract this abnormally low level, the knee can now be injected with a purified form of this substance which is obtained from rooster combs. This is particularly attractive because instead of using a substance that does not belong in the knee (cortisone), you are actually simply replacing the lubricant that belongs there.

What is Hyaluronate?

This naturally occurring chemical is actually a lubricant and a shock-absorber. It allows the knee to be as frictionless as possible. In fact, there is no artificial substance that has ever been developed that can be as slippery as the normal knee joint. Hyaluronate, for lack of a better description, can be though of injecting "grease" into our cars’ universal joints. It’s even better than that because it has a secondary effect as a shock absorber.

Who Can Use It?

Hyaluronate is usually indicated for people with mild to moderate osteoarthritis or wear and tear changes in the knee. It used when these people have not received relief from painkillers such as Tylenol and physical therapy. It avoids the side effects of anti-inflammatories such as Ibuprofen and Naproxen. If you have severe osteoarthritis your knee may be too far gone to benefit from this medication. A severely mal-aligned limb similarly may not benefit as much.

What to Expect

Like all injections, you may have some temporary but minor pain at the injection site. Occasionally, there is a local irritation. You need to get to receive three to five injections on a weekly basis before the medication will work. It reaches maximum benefit at eight to twelve weeks and can last six months to a year.


You should not receive these injections if you are allergic to similar products such as feathers, eggs, and poultry. You should also not have an injection if you have a local skin disease such a rash or infection. There are some possible risks such as allergic reaction. Infection can occur but should be quite rare if proper sterile technique is used. Like any injection, you may feel faint, drop your blood pressure, or feel unwell. This is rare.

Things to Know

Immediately after the injection, you have to take it easy and ice your knee. Expect to take two days off of vigorous activity such as jogging or standing on your feet for long periods of time. The safety of the medication in pregnant women and in children has not been established. There have been studies done in Germany and the United States to establish its safety in the general population. It has actually been used since 1987 in Europe, South America, and Asia. You can take virtually any medication at the same time as receiving this injection without any cross-reaction.

What About Cortisone?

Cortisone is still a good drug. It is a better drug than Hyaluronate if there is an underlying inflammatory component to the problem in the knee. In general, any problem occurring outside the joint such as a tendonitis would not respond to Hyaluronate. Instead, if you have to have an injection, it would be cortisone. We tend to use cortisone in the more severely advanced stages of osteoarthritis. Both medications have their place and you cannot say that one is better than the other. It is simply that they have different indications in different people.

Ask Your Physician

You should speak with your orthopedic surgeon whether or not you are a candidate for this medication. It does not work and is not indicated in all people for all problems, but it may be right for you.