Hyaluronic acid (HA) is a component of normal joint fluid. When joints becomes arthritic from osteoarthritis (a.k.a. wear and tear), the synovial lining (cells that make the fluid) manufactures fluid that is less viscous than in a normal joint. This “arthritic fluid” does not have the same ability to resist shear and compression forces as normal joint fluid and is not as effective at cushioning the joint or lubricating the surfaces.
The FDA has approved the use of manufactured HA as an injection into KNEE joints only with osteoarthritis. It is not FDA approved for us in other joints and is contra-indiccated in any type of arthritis other than osteoarthritis (i.e. Rheumatoid etc. Off label (use without FDA approval) use of HA may be considered when criteria is met and other treatments have failed for joints such as the shoulder, elbow and ankle. Because it is not FDA approved for these joints, many insurance plans will not pay for the cost of the injections, even though clinical evidence demonstrates an improvement in many patients’ symptoms.
There are several commercially available brands of HA approved for use in the United States. Dr. Bailie has over a decade of experience and success with HA in the knee, shoulder and elbow with several of these HA preparations. He has found that some work better than others and he has carefully chosen and uses the brands that have proven to be most effective over thousands of cases. Although many patients benefit from this therapy, proper patient selection is critical and requires an examination and specific types of Orthopedic x-rays to adequately evaluate the joint.
If the HA injections help to improve motion, alleviate pain and improve quality of life, they can be repeated, as necessary, as long as the positive effects last a minimum of 6 months.
The injections Dr. Bailie uses have a very high safety profile. They are given in weekly intervals, preferably for 5 weeks (although insurance often only covers 4 injections), in the office and usually local anesthesia is not required. Normal activity can resume immediately after the injection. Results are typically seen after the 3rd injection and the positive effect reaches a peak around 1-2 months following the last injection, and may last for years in some cases.
HA has also been shown to improve the outcomes of cartilage regeneration procedures and Dr. Bailie has used this, with injections beginning shortly after surgery, to improve chondrocyte (cartilage cell) health.
To learn more about this injectable products and to determine if you are a candidate, please make an appointment for an evaluation of your knee or shoulder.
REF: Miller, LE, Block JE: US-Approved Intra-Articular Hyaluronic Acid Injections are Safe and Effective in Patients with Knee Osteoarthritis: Systematic Review and Meta-Analysis of Randomized, Saline-Controlled Trials, doi 10.4137/CMAMD.S12743