Hyaluronic acid injections
A balanced guide to hyaluronic acid injections for osteoarthritis: what they are, what the evidence shows, and what to expect if you decide to have one
Hyaluronic acid injections are an established option for osteoarthritis, most often of the knee. Some people find them genuinely helpful; the research evidence is mixed, and the response varies a good deal from person to person. They are offered here as a private, self-pay treatment, considered after an honest discussion of what they can and cannot offer. This guide explains what they are, what the evidence shows, the difference between the NHS and private picture, and what to expect if you decide to have one.
Written for patients and reviewed by Dr Liubov Borukhson, Consultant Rheumatologist (GMC 7021928). Last clinically reviewed: June 2026.
What is a hyaluronic acid injection?
Hyaluronic acid is a natural component of the fluid that lubricates and cushions your joints. In osteoarthritis this fluid can lose some of its normal thickness and elasticity. A hyaluronic acid injection places a gel-like preparation of the same substance directly into the joint to supplement its own fluid; you may also hear the approach called viscosupplementation. It is used most often for the knee, and sometimes for other large joints such as the hip or shoulder.
It is a different idea from a steroid injection. A steroid is an anti-inflammatory medicine, at its most useful when a flare of inflammation needs settling quickly. A hyaluronic acid preparation contains no steroid and is not designed to damp down a flare: the aim is slower and gentler, to improve the day-to-day comfort of a worn joint over a longer period. It is also classed as a medical device rather than a medicine.
What does the evidence show?
Studies of hyaluronic acid in osteoarthritis have produced mixed results: some people report worthwhile relief, others notice little or no benefit, and the average effect across trials is modest. The evidence is genuinely not clear-cut. NICE, which advises the NHS, does not recommend hyaluronic acid injections for osteoarthritis, and it is worth being clear about what that recommendation is and is not. NICE weighs not only how well a treatment works but whether it is good value for limited NHS resources; its decision here rests on the modest average benefit together with cost-effectiveness for the health service. It is a judgement about NHS funding, not a finding that the treatment never helps anyone.
That funding judgement does not carry across to private care, where you pay for the treatment yourself and the question becomes a more personal one: whether the possible benefit is worth the cost to you. For this reason it is a self-pay option, and we are not aware of any private medical insurer that currently covers it. Because individual responses vary so widely, a treatment with a modest average effect can still be well worth it for a particular person, and many people do report real benefit in practice. It cannot be promised in advance, but it is a reasonable option to consider, particularly where a steroid injection is unsuitable or has stopped helping, or where you would prefer to put off or avoid joint replacement. Dr Borukhson will give you a frank, balanced view of whether it is worth trying in your situation, and will say so just as honestly if she thinks it is not.
What happens at the practice
No one is offered an injection on the strength of a sore knee alone. The starting point is a proper assessment: your history, an examination and, where helpful, point-of-care ultrasound during the same consultation. The scan helps establish what is actually going on in the joint, and sometimes shows that a different approach would serve you better. If, after an honest discussion, you decide to go ahead, the injection can usually be given in the same visit as an ultrasound-guided injection, so the preparation is placed accurately inside the joint.
The preparation used at the practice is OSTENIL PLUS, made by TRB Chemedica. The manufacturer describes it as a solution of highly purified sodium hyaluronate (hyaluronic acid) developed specifically for the treatment of osteoarthritis, with added mannitol to help stabilise the hyaluronic acid chains. It is designed to be given as a single injection per treatment cycle in large joints such as the knee, hip and shoulder, rather than as a course of weekly injections, and the manufacturer states that repeat treatment cycles may be given as required. The practice is a registered Ostenil Approved Clinic, part of the manufacturer's UK scheme that exists to reassure patients that the preparation they receive is an authentic OSTENIL product.
What a realistic result looks like
Do not judge the injection on the day it is given. There is nothing in the preparation designed to work quickly, so any benefit tends to build gradually over several weeks. When the treatment works, the usual reward is a more comfortable joint for some months, and the manufacturer allows for the treatment cycle to be repeated if a worthwhile benefit later wears off.
Not everyone benefits, and there is no test that reliably predicts who will, so it is sensible to treat the first injection as a trial: give it several weeks, judge the result against how the joint felt beforehand, and repeat it only if it has clearly helped. Whatever the outcome, the core measures for osteoarthritis, such as exercise, strengthening and weight management where relevant, remain worthwhile alongside it, and are covered in the osteoarthritis guide.
Aftercare, and a word of warning
Afterwards you can usually go straight home. It is sensible to rest the joint and avoid strenuous activity for a day or two, then build back up gradually; any specific aftercare for your joint is explained at the time.
A few people notice a temporary flare of pain or swelling in the injected joint for a day or two; this settles on its own. Infection after a joint injection is rare, but it matters: if the joint becomes increasingly hot, swollen and very painful in the days afterwards, or you develop a fever or feel unwell, seek medical advice urgently rather than waiting for it to pass.
Considering a hyaluronic acid injection?
An honest assessment, with ultrasound where helpful, can establish what is going on in the joint and whether this treatment is genuinely worth considering in your case
Book an appointment