Hyaluronic acid (HA) Gel injections

Hyaluronic acid (HA) injections, aka viscosupplementation or “Gel shots”


Gel shots are a safe and effective alternate to steroids and surgery. If you are trying to stave off surgery and avoid steroids, this could be a great option for you. HA is used for joints that have “wear and tear” and/or arthritis such as in former athletes and active adults. As we age and with prior trauma or knee surgery, we lose cartilage and fluid in the joint tends to become “watery” as opposed to children who have joint fluid that is very viscous (“gel like”). “Watery” fluid in the joint cannot support the knee as well as viscous fluid in the joint and therefore leads to further “wear and tear” otherwise known as “arthritis.” To sustain function and avoid joint surgery, gel shots can be a great treatment option.

Gel shots promote decreased inflammation, improved viscosity (thickness) of joint fluid for better glide and support lending to decreased breakdown of cartilage. There is extensive data to support this treatment including 4 level I clinical trials and over 1,000,000 patients have had this treatment worldwide. It is primarily used for knees, but it may be applied to other joints as well, such as shoulders, wrists, fingers, and toes.

There are several key factors that play a role in ensuring gel shots are successful for each candidate. First, patient selection is important as not all patients are good candidates. Multiple factors effect patient selectivity including other health issues, weight, and lifestyle. Secondly, it is imperative to have an experienced provider who can effectively inject into the targeted area using ultrasound guidance. Lastly, use of high quality gel product can make a substantial difference in the outcome.


Hyaluronic acid is a naturally occurring substance in your body. The products we use are high molecular weight versions and are designed to stay in the joint for an extended period of time. The products we use are either extracted from rooster combs or created from bacterial fermentation (for those allergic to poultry).

We apply the gel directly inside the joint using ultrasound guidance. Depending on the product used, you may receive one shot or a series of 5 shots, 1-2 weeks apart. This can be determined further at your visit.

The goal of this treatment is to:

  • Decrease pain
  • Decrease inflammation
  • Improve function
  • Prevent further degeneration process
  • Delay or avoid need for surgery


  • Anesthetize (“numb”) the skin and the joint for injection
  • Inject the gel product into the joint using ultrasound guidance (takes about 30 seconds and is usually not painful)
  • Rest for the remainder of the day/evening (may exercise just before the injection if desired)


You may feel mild soreness or “fullness” for 2-3 days after the injection. Rarely, patients will experience these symptoms for longer, up to 7-10 days. Most patients do not experience any significant discomfort.

You may use over the counter anti-inflammatories or analgesics (Acetaminophen, Ibuprofen, Naproxen, Arnica, or lidocaine). Use of ice is permitted.

You may return to physical therapy or sport by day 3. This will be discussed more fully on an individual basis.

It can take 4-6 weeks on average for the “full effect” of the gel shot. We aim for 50% or more relief, lasting 6+ months or more. In ideal candidates, this treatment can provide benefits for up to 2-3 years. Early treatment intervention is key! The less wear and tear you have, the better the treatment response.

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With gel shot treatment, risk is very low. The main component that can pose risk is the injection itself. Studies show complication from the actual product is almost none.


It is most valuable to schedule a consultation to discuss your issue, goals, and whether gel shot treatment is the best option for you. We look forward to meeting you!

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