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Halcy Orthopedics

Hyaluronic Acid Injection in New York

Also known as: Viscosupplementation, HA Injection, Knee Gel Injection, Intra-Articular Hyaluronic Acid, Knee Viscosupplementation, Hyaluronan Injection

4 min readLast updated: 2026-05-10
Reviewed by Dr. Maya Chen, MD, FAAOS

Hyaluronic acid injection, also known as viscosupplementation, is an intra-articular procedure in which a gel-like fluid is injected directly into the knee joint to supplement the natural synovial fluid that lubricates and cushions the cartilage. It is most commonly used to relieve pain and improve joint function in adults with mild to moderate knee osteoarthritis who have not responded adequately to first-line measures such as physical therapy, weight management, and oral analgesics. Treatment is typically delivered as a single injection or a short series of weekly injections in a clinic setting.

At a Glance

  • Hyaluronic acid is a naturally occurring component of synovial fluid that contributes to joint lubrication and shock absorption[1]
  • Treatment is typically delivered as a single injection or a series of three to five weekly injections, depending on the product used[5]
  • The most common side effect is a self-limited reaction at the injection site, and serious adverse events are uncommon[3]
  • The 2021 AAOS clinical practice guideline does not recommend hyaluronic acid injections for routine use in symptomatic knee osteoarthritis[7]

Overview

Hyaluronic acid is a naturally occurring polysaccharide found in healthy joint fluid, where it contributes to lubrication and shock absorption. In osteoarthritic knees, the concentration and molecular weight of hyaluronic acid in the synovial fluid often decline, which can contribute to pain, stiffness, and reduced function. Viscosupplementation aims to restore some of these properties by introducing supplemental hyaluronic acid directly into the joint space.

The procedure is most commonly performed for knee osteoarthritis, although it has been studied off-label for osteoarthritis of the hip, shoulder, and other joints. Several formulations are available, including products derived from rooster combs (avian-sourced) and bioengineered bacterial-fermentation products. Treatment regimens vary by product, with some delivered as a single injection and others as a series of three to five weekly injections.

Clinical evidence on viscosupplementation is mixed. Multiple meta-analyses and randomized trials have reported modest improvements in pain and function compared with placebo, particularly in the first several months after injection. The American Academy of Orthopaedic Surgeons (AAOS) does not recommend routine use of hyaluronic acid injections for symptomatic knee osteoarthritis in its 2021 clinical practice guideline, while other international guidelines consider it a reasonable option for selected patients. Shared decision-making between patient and clinician is important when considering this treatment.

What to Expect During Treatment

  1. 1Initial evaluation including history, physical examination, and imaging such as weight-bearing knee radiographs to confirm osteoarthritis and grade severity
  2. 2Shared decision-making discussion of benefits, risks, alternatives, and realistic expectations for symptom relief
  3. 3Patient is positioned with the knee slightly bent or extended depending on the chosen injection approach
  4. 4Skin over the injection site is cleaned with antiseptic solution and sterile technique is established
  5. 5Local anesthetic may be applied to the skin and soft tissues to reduce procedural discomfort
  6. 6Hyaluronic acid is injected into the joint space using a sterile needle, sometimes with ultrasound guidance to confirm intra-articular placement
  7. 7A small bandage is applied and the patient is observed briefly for immediate reactions before discharge with post-procedure instructions

How does Hyaluronic Acid Injection work?

  • A small volume of hyaluronic acid solution is injected directly into the synovial cavity of the affected joint, most commonly the knee, where it mixes with the existing joint fluid.
  • The supplemental hyaluronic acid is thought to improve the viscous and elastic properties of the synovial fluid, helping the joint act more effectively as a lubricant during slow movements and as a shock absorber during higher-impact activities.
  • Beyond mechanical effects, hyaluronic acid may have anti-inflammatory and chondroprotective activity in the joint. Laboratory studies suggest it can down-regulate pro-inflammatory cytokines and reduce certain enzymes that contribute to cartilage breakdown, although the clinical significance of these effects continues to be studied.
  • Injected hyaluronic acid is cleared from the joint over days to weeks, but symptomatic benefit can persist for several months in patients who respond. The mechanism by which clinical benefit outlasts the physical presence of the injected material is not fully understood.

When It's Recommended

  • Symptomatic knee osteoarthritis of mild to moderate severity
  • Persistent knee pain despite physical therapy and activity modification
  • Persistent knee pain despite weight management efforts
  • Knee osteoarthritis in patients who have not responded to oral analgesics
  • Knee osteoarthritis in patients who are not candidates for or who wish to delay joint replacement surgery
  • Knee osteoarthritis in patients who cannot tolerate nonsteroidal anti-inflammatory medications
  • Selected cases of shoulder osteoarthritis (off-label use)
  • Selected cases of hip osteoarthritis (off-label use)

Recovery & Aftercare

  • Most patients can resume light activities the same day, though strenuous activity is typically limited for 24 to 48 hours
  • Mild soreness, swelling, or stiffness at the injection site is common in the first one to three days
  • Ice may be applied to the joint for short periods to reduce discomfort and swelling after the injection
  • Strenuous weight-bearing exercise, prolonged standing, and high-impact activity are often deferred for one to two days
  • Symptomatic improvement, when it occurs, typically develops gradually over several weeks rather than immediately
  • Benefit, when present, often lasts up to six months, with some patients experiencing longer-lasting relief
  • Repeat courses can be considered after a treatment-free interval if the initial course provided meaningful relief

Alternative Treatments

  • Physical therapy and structured exercise programs
  • Weight management to reduce mechanical load on the joint
  • Oral or topical nonsteroidal anti-inflammatory medications
  • Intra-articular corticosteroid injection
  • Platelet-rich plasma (PRP) injection
  • Bracing, orthotics, or assistive devices
  • Total or partial knee replacement surgery for advanced disease

Related Treatments

PRP TherapyCortisone InjectionPhysical Therapy

Frequently Asked Questions

A hyaluronic acid injection, also called viscosupplementation, is a procedure in which a gel-like fluid is injected directly into a joint, most often the knee, to supplement the natural lubricating fluid found in healthy joints. It is most commonly used to help relieve pain and improve function in adults with mild to moderate knee osteoarthritis.
Most patients describe the injection as briefly uncomfortable rather than painful. A topical or local anesthetic may be used to reduce sensation at the skin. Mild soreness, swelling, or stiffness in the treated joint can occur for one to three days afterward and typically resolves on its own.
When viscosupplementation works, symptom improvement typically develops gradually over several weeks rather than immediately. Benefit, when present, often lasts up to six months, and some patients experience longer-lasting relief. Response varies between individuals.
It depends on the specific product. Some hyaluronic acid preparations are given as a single injection, while others are delivered as a series of three to five weekly injections. Your clinician will discuss the regimen that fits the product used and your treatment goals.
The most common side effects are temporary pain, swelling, or stiffness at the injection site that resolves within a few days. Rare adverse events include post-injection inflammatory flare, pseudoseptic reactions, allergic reactions, and joint infection. See the safety section above for the full risk profile.
Hyaluronic acid injections may not be appropriate for people with active infection or skin disease at the injection site, septic arthritis, known hypersensitivity to hyaluronic acid, or known allergy to avian proteins or eggs when an avian-derived product is being considered. They are also generally avoided during pregnancy or breastfeeding due to limited safety data.
Clinical evidence is mixed. Multiple studies report modest improvements in pain and function compared with placebo, particularly in the first several months after treatment. The American Academy of Orthopaedic Surgeons does not recommend routine use of hyaluronic acid injections in its 2021 knee osteoarthritis guideline, while other international guidelines consider them an option for selected patients.
Hyaluronic Acid Injection is available at our Manhattan Flagship office (401 Park Avenue South, Suite 800, New York, NY 10016); our Brooklyn Heights office (75 Henry Street, Suite 320, Brooklyn, NY 11201). Contact our office to schedule an appointment at the location most convenient for you.

Your Practitioner

Dr. Maya Chen, MD, FAAOS

Fellowship-trained orthopedic surgeon specializing in cartilage preservation and minimally-invasive joint procedures. Dr. Chen treats high-performance athletes and weekend warriors alike, with a focus on returning patients to the activities they love.

Dr. Marcus Rivera, MD

Spine surgeon with subspecialty training in motion-preserving cervical procedures. Dr. Rivera has performed more than 2,000 cervical disc replacements and lectures internationally on navigation-assisted spine surgery.

Dr. Priya Nair, MD

Non-operative sports medicine physician focused on regenerative orthopedic care. Dr. Nair leads the practice's PRP and ultrasound-guided injection programs, and serves as team physician for two NYC-area collegiate athletic departments.

Medically reviewed by Dr. Maya Chen, MD, FAAOS · Last reviewed: 2026-05-11