Viscosupplementation FAQ: Your Questions Answered

Frequently Asked Questions About Viscosupplementation

Find answers to the most common questions about hyaluronic acid (HA) injections for osteoarthritis. If you don’t see your question below, contact us for personalized guidance.

General Questions

What is viscosupplementation?

Viscosupplementation is a treatment that involves injecting hyaluronic acid (HA) gel directly into your joint. The HA acts as a lubricant and shock absorber, similar to the natural synovial fluid in healthy joints. It’s FDA-approved for knee osteoarthritis and is sometimes used off-label for hip and shoulder arthritis.

How is it different from cortisone shots?

Are gel shots and HA injections the same thing?

Yes. “Gel shots” is a common term for hyaluronic acid injections. Other terms include:

• Viscosupplementation
• Hyaluronic acid injections
• HA injections
• Rooster comb injections (older term)
• Joint lubrication injections

Effectiveness Questions

Does viscosupplementation really work?

Clinical research shows that 50-70% of patients experience meaningful pain relief from HA injections. Effectiveness depends on several factors:

Better outcomes with:

• Mild-to-moderate osteoarthritis
• Accurate injection placement (imaging-guided)
• Realistic expectations
• Combined with physical therapy

Less effective for:

• Severe, bone-on-bone arthritis
• Inflammatory arthritis
• Very young or very old patients

How long do the results last?

Most patients experience relief for 6-12 months. Duration varies based on:

• Severity of arthritis
• Activity level
• Body weight
• Which product was used
• Accuracy of the injection

How many injections will I need?

This depends on the product:

Can viscosupplementation delay knee replacement surgery?

Yes, for many patients. Studies show that appropriate candidates can delay knee replacement by several years with regular HA injections. However, it doesn’t prevent the need for surgery in patients with severe arthritis—it can extend the time with your natural knee.

Procedure Questions

Does the injection hurt?

Most patients describe the injection as mild discomfort, similar to a blood draw. Your doctor may:

• Apply numbing spray to the skin
• Inject local anesthetic first
• Use a very thin needle

Any soreness typically resolves within 24-48 hours.

How long does the procedure take?

The injection itself takes only 2-5 minutes. With preparation, paperwork, and observation, expect to spend 15-30 minutes total at the clinic.

Will I need imaging guidance?

Recommended but not always required for knees. Studies show imaging guidance improves accuracy:

• Fluoroscopy (X-ray) - Gold standard, ensures needle is in joint
• Ultrasound - Real-time guidance, no radiation
• Blind injection - May miss joint space up to 30% of the time

For hip and shoulder injections, imaging guidance is essential due to the deep location of these joints.

Can I drive after the injection?

Yes. Most patients can drive themselves home. Your knee may be slightly stiff, but this doesn’t prevent driving.

What should I do after the injection?

First 24-48 hours:

• Avoid strenuous activities
• Apply ice if you experience soreness
• Light walking is fine and encouraged
• Take acetaminophen if needed

First week:

• Resume normal activities gradually
• Avoid high-impact sports
• Continue any prescribed physical therapy

Safety Questions

What are the side effects?

Most side effects are mild and temporary:

Common (5-10% of patients):

• Injection site soreness
• Mild swelling
• Warmth at injection site

Uncommon (less than 1%):

• Allergic reaction
• Joint infection (very rare)
• Pseudosepsis (sterile inflammation)

Who should NOT get viscosupplementation?

HA injections are not recommended for:

• Active joint or skin infection
• Known allergy to hyaluronic acid
• Certain allergies to avian products (use non-avian brands)
• Significant bleeding disorders (relative contraindication)
• Pregnancy (safety not established)

Can I get HA injections if I’m allergic to eggs?

Yes, with the right product. Some HA products come from avian (bird) sources, but alternatives exist:

Always inform your doctor about any allergies.

Is viscosupplementation FDA-approved?

Yes, for knee osteoarthritis. All HA products are FDA-approved specifically for treating knee OA. Use in other joints (hip, shoulder, ankle) is considered “off-label” but legal based on physician judgment.

Insurance & Cost Questions

Does Medicare cover viscosupplementation?

Yes. Medicare Part B covers HA injections for knee osteoarthritis when medically necessary. You’ll typically pay:

• Annual Part B deductible
• 20% coinsurance (Medicare pays 80%)

Medicare Advantage plans may have different requirements—check your specific plan.

What are the requirements for Medicare coverage?

1. Documented knee osteoarthritis diagnosis
2. X-ray evidence of arthritis
3. Failed conservative treatment (6+ weeks of PT, medications)
4. Medically necessary determination

Does private insurance cover it?

Usually yes, but requirements vary. Most plans require:

• Prior authorization
• Documentation of failed conservative care
• Use of in-network providers

Check with your specific insurer before treatment.

How much does viscosupplementation cost?

Can I get both knees treated?

Yes. Both knees can be treated in the same visit or separately, depending on your doctor’s recommendation and insurance coverage.

Comparing Brands

Which HA brand is best?

No single brand is “best” for everyone. Choice depends on:

• Schedule preference - Single injection vs. multiple visits
• Allergies - Avian vs. non-avian source
• Insurance coverage - Some plans prefer certain brands
• Doctor’s experience - Familiarity with specific products

Compare all FDA-approved HA brands →

Are single-injection brands better?

They’re more convenient, not necessarily more effective. Single-injection and multi-injection products show similar effectiveness in studies. Choose based on:

• Your schedule (fewer office visits vs. more)
• Insurance preferences
• Doctor’s recommendation

What’s the difference between high and low molecular weight HA?

Research hasn’t definitively proven one type superior to others.

Lifestyle Questions

Can I exercise after getting HA injections?

Yes, with modifications:

• First 48 hours: Rest, light walking only
• Week 1: Resume daily activities, avoid high-impact
• After week 1: Gradually return to normal exercise
• Long-term: Low-impact exercise (swimming, cycling) is beneficial

Will HA injections affect my golf/tennis/gardening?

Most patients return to these activities within 1-2 weeks. Many report significant improvement in their ability to enjoy recreational activities after treatment.

Do I need to lose weight before getting HA injections?

Weight loss isn’t required, but it helps. Every pound of weight loss reduces knee stress by 4 pounds. Combining HA injections with weight management often produces better, longer-lasting results.

Can I continue taking my arthritis medications?

Yes. HA injections can be used alongside:

• NSAIDs (ibuprofen, naproxen)
• Acetaminophen
• Glucosamine supplements
• Prescription pain medications

Discuss your medications with your doctor.

Getting Started

How do I know if I’m a candidate?

You may be a good candidate if you have:

• Diagnosed knee osteoarthritis
• Tried conservative treatments without adequate relief
• Mild-to-moderate (not severe) arthritis
• Desire to avoid or delay surgery

Take our candidacy assessment →

What should I bring to my appointment?

• Recent X-rays or imaging results
• List of current medications
• Treatment history (what you’ve tried)
• Insurance card and prior authorization (if required)
• Questions for your doctor

What questions should I ask my doctor?

1. Am I a good candidate based on my X-rays?
2. Do you use imaging guidance for injections?
3. Which HA product do you recommend and why?
4. How many injections will I need?
5. What results have your patients experienced?
6. Is prior authorization required for my insurance?

Have a question we didn’t answer? Contact us or explore our viscosupplementation hub for more information.