Hyaluronic acid (HA) Gel injections

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


Gel shots are a low risk, high reward option using your body’s own healing properties. It is used for joints that have “wear and tear” and/or arthritis such as former athletes or active adults. As we use our joints over the years (and if you have had prior injury or surgery), we lose cartilage and our fluid in the joint tends to become for “watery” and less viscous “gel like.” This can cause a less smoothly working joint and can hasten further wear and tear. To continue function and avoid joint surgery, gel shots can be a great treatment option to try.

Gel shots promote decreased inflammation, improved viscosity (thickness) of joint fluid known as “synovial fluid” for better glide, and protects further 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 keys to making gel shots successful. It is important to ensure the right candidate and the provider should have extensive experience to place the gel in the right place using ultrasound guidance. Also, like with so many things in life regarding quality, not all gel products are created equally. We use the highest quality products available.


Hyaluronic acid is a naturally occurring substance in your body. The products we use are high molecular weight versions and are 3D design to stay in the joint for an extended time, some longer than others. Product is 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 3-5 shots, 1-2 weeks apart. This can be custom designed 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 15-30 seconds and is usually not painful)
  • Rest for the remainder of the day/evening (may exercise just before the injection if desired)


It is normal to feel mild soreness or “fullness” for 2-3 days and rarely longer than that. Many patients do not experience any discomfort at all. Take it easy and “listen to your body” during this time. Eat well and rest a little more than usual. It will be worth it in the long run.

You may use over the counter anti-inflammatories or analgesics (Acetominophen, NSAIDS, Arnica, or lidocaine). Use of ice is also an option.

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

It takes 4-6 weeks on average for the “full effect” but can take up to 8 weeks. Ideally, we aim for 50% or more relief, lasting 6+ months. In ideal candidates, this treatment can provide benefit for up to 2-3 years. Early treatment intervention is key! The less wear and tear you have, the better the treatment.

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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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