Why Your Doctor May Not Have Mentioned Gel Injections
Many patients never hear about gel injections for knee arthritis. Learn why doctors may not mention viscosupplementation and how to start the conversation.
By Joint Pain Authority Team
The Treatment Gap You Should Know About
If you have knee osteoarthritis and have never heard your doctor mention gel injections (viscosupplementation), you are not alone. Millions of patients who might benefit from this Medicare-covered treatment are never told it exists.
This is not about bad doctors. It is about a healthcare system where:
- Different medical guidelines conflict with each other
- Specialists have different training and treatment preferences
- Time constraints limit what gets discussed
- Insurance complexity discourages certain recommendations
Understanding why this happens empowers you to have better conversations with your healthcare team.
The Awareness Gap Is Real
Hyaluronic acid injections have been FDA-approved for knee osteoarthritis since 1997. Medicare has covered them for nearly three decades. Yet many patients reach the point of considering surgery without ever learning this option exists.
A 2019 survey found that fewer than half of osteoarthritis patients had discussed viscosupplementation with their doctors, even when they were potential candidates. This gap exists not because gel injections are ineffective, but because of several systemic factors that influence what treatments doctors recommend.
Why Many Doctors Do Not Bring It Up
1. Conflicting Medical Guidelines
The Guideline Confusion
Different professional organizations have issued conflicting recommendations about viscosupplementation:
| Organization | Year | Recommendation |
|---|---|---|
| AAOS | 2013, 2022 | Recommends against |
| OARSI | 2019 | Conditionally recommends FOR |
| VA/DoD | 2020 | Conditionally recommends |
| ACR | 2019 | Conditionally recommends |
When guidelines disagree, doctors often follow the most conservative recommendation or the one from their primary professional organization.
The American Academy of Orthopaedic Surgeons (AAOS) published guidelines recommending against viscosupplementation. However, the Osteoarthritis Research Society International (OARSI), the American College of Rheumatology (ACR), and the VA/DoD clinical guidelines all conditionally recommend it for certain patients.
This creates a situation where your orthopedic surgeon may be following different guidelines than a rheumatologist or pain management specialist would follow. Neither is wrong. They are simply following different evidence interpretations from their respective professional bodies.
2. Specialty-Specific Treatment Preferences
Orthopedic Surgeons
- Trained primarily in surgical techniques
- May view injections as temporary measures
- Focus often on when surgery is appropriate
- May not perform injections themselves
Primary Care Physicians
- See broad range of conditions
- May have limited training in joint injections
- Often refer complex cases to specialists
- May not be familiar with procedure details
Rheumatologists
- Focus on inflammatory arthritis conditions
- May prefer systemic medications
- Osteoarthritis may be seen as outside specialty
- May refer to other specialists for injections
Pain Management Specialists
- Often familiar with injection therapies
- More likely to discuss gel injections
- May have imaging guidance equipment
- Focus on non-surgical pain relief
Different training backgrounds lead to different comfort levels with various treatments. An orthopedic surgeon trained to perform knee replacements may naturally think in terms of surgical timelines, while a pain management specialist may focus on maximizing conservative options first.
3. Time Constraints in Modern Healthcare
The 15-Minute Appointment Problem
The average primary care appointment is just 15-18 minutes. In that time, doctors must:
- Review your current medications
- Address your primary complaint
- Examine you physically
- Document everything for the medical record
- Answer your questions
Discussing a treatment option that requires explaining what it is, how it works, insurance coverage, and procedure details simply takes more time than writing a prescription or scheduling a surgery referral.
It is often faster and simpler to prescribe an oral medication or refer to a surgeon than to explain a treatment the patient has never heard of. This is not laziness. It is the reality of a healthcare system that does not reward time spent in patient education.
4. Insurance Barriers and Prior Authorization
Insurance Complexity
While Medicare covers viscosupplementation, private insurance is less consistent:
- Approximately 30% of private insurers do not cover gel injections
- Prior authorization requirements add administrative burden
- Coverage varies by specific plan, even within the same insurance company
- Denials and appeals take significant staff time
Some doctors avoid recommending treatments they know may not be covered, not wanting to raise hopes for something a patient cannot access or afford.
When a doctor knows their patient has insurance that often denies gel injection coverage, they may not mention it to avoid frustration or the appearance of recommending something unattainable. While well-intentioned, this means patients never learn about options they could potentially access through appeals or out-of-pocket payment.
5. Marketing Disparities
The Visibility Problem
You have probably seen television commercials for:
- Arthritis pain medications (Celebrex, Advil, Tylenol)
- Knee replacement surgery (hospital advertising)
- Joint supplements (Osteo Bi-Flex, Move Free)
You have probably never seen a commercial for viscosupplementation brands like Synvisc, Euflexxa, or Supartz.
Hyaluronic acid injection manufacturers do not engage in direct-to-consumer advertising the way pharmaceutical companies do for oral medications. This means patients simply do not know to ask about it.
When patients have seen advertisements for a treatment, they often bring it up with their doctors. When they have never heard of something, they cannot ask about it. The lack of consumer marketing for viscosupplementation products creates an information gap that keeps many patients unaware of their options.
What This Means for You
Understanding these systemic factors is not about blaming doctors. Most physicians genuinely want to help their patients and work within the constraints of a complicated system. The key insight is that you may need to be an active participant in exploring your treatment options.
The Empowered Patient Approach
When you understand why certain treatments may not come up in conversation, you can:
- Ask specifically about options you have researched
- Request referrals to specialists who may have different perspectives
- Understand that one doctor’s recommendation is not the only viewpoint
- Advocate for yourself without being adversarial
How to Start the Conversation
Opening the Discussion
What to Say
Try these conversation starters:
-
“I’ve been reading about gel injections for knee arthritis. Am I a candidate?”
- Shows you have done research
- Opens the door for discussion
- Puts you in an active role
-
“Before we discuss surgery, can we talk about all the non-surgical options?”
- Signals your preferences clearly
- Ensures nothing gets skipped
- Invites comprehensive discussion
-
“What do you think about viscosupplementation for someone with my condition?”
- Uses medical terminology to show familiarity
- Directly asks for professional opinion
- Creates space for honest dialogue
-
“I know different guidelines exist for this treatment. What’s your experience been?”
- Acknowledges the complexity
- Asks for personal clinical experience
- Shows respect for their expertise
Questions to Ask Your Doctor
Once the conversation is open, consider asking:
About your specific situation:
- Based on my X-rays and symptoms, would I be a candidate for hyaluronic acid injections?
- What outcomes have you seen with your patients who have tried this treatment?
- Are there reasons you would not recommend it for me specifically?
About the procedure:
- Do you perform gel injections, or would you refer me to a specialist?
- Would the injection be done with imaging guidance (fluoroscopy or ultrasound)?
- How many injections would be involved, and over what timeframe?
About insurance and access:
- Do you know if my insurance typically covers this treatment?
- If my primary insurance does not cover it, what would the out-of-pocket cost be?
- Is there a prior authorization process we should start?
If Your Doctor Recommends Against It
If your doctor does not recommend gel injections, ask why. Valid reasons might include:
- Your arthritis is too mild to qualify under insurance guidelines
- Your arthritis is too severe for injections to likely help
- You have an allergy to hyaluronic acid products
- You have had a genuine lack of response to previous injections
However, if the reasoning is simply “I don’t do those” or “the guidelines say not to,” you may want to:
- Ask for a referral to a specialist who does offer the treatment
- Seek a second opinion from a pain management or sports medicine provider
- Research providers in your area who specialize in non-surgical joint treatments
Finding the Right Provider
If you decide to pursue gel injections, look for providers who:
- Use imaging guidance (fluoroscopy or ultrasound) for accurate placement
- Have experience with viscosupplementation specifically
- Accept your insurance and can verify coverage before treatment
- Take time to answer your questions and explain the process
- Set realistic expectations about outcomes
Interventional pain management specialists, sports medicine physicians, and some orthopedic practices specialize in these procedures and may be more familiar with the latest evidence and techniques.
The Bottom Line
The fact that your doctor has not mentioned gel injections does not mean they are not right for you. Healthcare is complex, guidelines conflict, and time is limited. Being an informed, active participant in your care means understanding these dynamics and asking the right questions.
You have the right to:
- Know about all your treatment options
- Understand why certain treatments are or are not recommended for you
- Seek second opinions
- Make informed decisions about your own healthcare
For many patients with knee osteoarthritis, viscosupplementation offers a middle ground between doing nothing and having surgery. Whether it is right for you depends on your specific situation, but you deserve to have that conversation.
Frequently Asked Questions
Why hasn’t my orthopedic surgeon mentioned gel injections?
Orthopedic surgeons often follow AAOS guidelines, which do not recommend viscosupplementation. They may also focus on surgical options as their specialty. This does not mean gel injections would not help you, just that your surgeon may be following different guidelines than other specialists would.
Should I get a second opinion from a different type of doctor?
If you have only discussed your knee arthritis with one type of specialist, consulting another can provide different perspectives. Pain management specialists and sports medicine physicians often have more experience with injection therapies and may offer options not discussed by your first doctor.
Will my doctor be offended if I ask about treatments they haven’t mentioned?
Most doctors appreciate informed patients who engage in their care. Asking about specific treatments shows you are invested in finding solutions. A good doctor will explain why they did or did not recommend something and respect your desire to understand all your options.
Is it true that gel injections don’t work?
Clinical evidence is mixed, which is why guidelines differ. Many patients experience significant relief lasting 6-12 months. Others see minimal benefit. Whether they work for you depends on factors like your arthritis severity, injection accuracy, and individual response. The treatment has been FDA-approved and Medicare-covered for nearly 30 years because it does help many patients.
How do I know if gel injections might work for me?
Ideal candidates typically have mild to moderate knee osteoarthritis, have tried other conservative treatments like physical therapy and anti-inflammatory medications, and are looking to delay or avoid surgery. Your doctor can assess your X-rays and symptoms to determine if you are a potential candidate.
What if my insurance does not cover gel injections?
Medicare covers viscosupplementation for knee osteoarthritis. If you have private insurance that does not cover it, you may be able to appeal the denial, especially if you have documentation of failed conservative treatments. Some patients also choose to pay out-of-pocket, with costs typically ranging from $500 to $1,500 per injection series.
Take the Next Step
Not sure if you’re a candidate for gel injections?
Take our 3-minute Knee Health Score Quiz to learn more about your options and whether viscosupplementation might be right for your situation.
Take the Quiz
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References
- Bannuru RR, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and Cartilage. 2019.
- American Academy of Orthopaedic Surgeons. Treatment of Osteoarthritis of the Knee: Evidence-Based Guideline, 2nd Edition. 2013.
- Kolasinski SL, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care & Research. 2020.
- VA/DoD Clinical Practice Guideline for the Non-Surgical Management of Hip and Knee Osteoarthritis. 2020.
- Stitik TP, et al. Hyaluronan therapy: reducing the treatment gap in knee osteoarthritis. Postgraduate Medicine. 2019.
Related Resources
Why Patients Don’t Know
Understanding the Treatment
- The FDA-Approved Treatment 80% of Patients Have Never Heard Of
- FDA-Approved Since 1997: The 27-Year History of Gel Injections
- The Clinical Evidence: What 6,000+ Patients Show
Insurance and Coverage
- Does Medicare Cover Gel Injections? 2026 Guide
- Why 30% of Insurance Plans Don’t Cover Gel Injections
Surgery Delay Evidence
- Can Gel Injections Delay Knee Replacement? 182,000-Patient Study
- 75% of “Bone-on-Bone” Patients Delayed Surgery 7+ Years
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