Regenerative Medicine · Dr. Andrew Dold · Frisco, TX

Hyaluronic Acid (Gel) Injections for Knee and Hip Arthritis

Gel injections, also called viscosupplementation, add a lubricating gel to an arthritic joint to ease pain and stiffness. Dr. Dold offers them for the knee and, under X-ray guidance, the hip. Here is how they work, who they help and what the research shows.

Request an AppointmentCall 469-850-0680All biologic treatments
A non-steroid optionHyaluronic acid is a natural component of healthy joint fluid.
Single or seriesDepending on the product, one injection or a series of injections.
Knee and hipKnee injections in the office; hip injections under fluoroscopic (X-ray) guidance.
Often covered for the kneeMedicare and many insurers cover knee gel injections when criteria are met.
What it isKneeHipCompareWhat to expectInsuranceResearch

What is hyaluronic acid?

Hyaluronic acid is a gel-like substance found naturally in the fluid that lubricates and cushions your joints. In osteoarthritis, the amount and quality of hyaluronic acid in the joint fluid decrease. A gel injection, or viscosupplementation, places hyaluronic acid directly into the joint. It is thought to improve lubrication and shock absorption, and it may have protective and anti-inflammatory effects within the joint.1

Products differ in their source, molecular weight and number of injections. A meta-analysis of 68 studies found that these differences influence both effectiveness and side effects, for example with higher molecular weight and non-animal (fermentation-derived) products.1 Dr. Dold uses both single-injection and multi-injection products, chosen based on your joint and your insurance coverage.

Gel injections for knee arthritis

Gel injections have been studied in more than a hundred trials,2 and the research is mixed. Supportive findings include:

  • A Cochrane review of 76 trials found pain improved by 28% to 54% from baseline 5 to 13 weeks after injection, with longer-lasting benefit than cortisone injections.3
  • A meta-analysis of 54 trials found the benefit began by 4 weeks, peaked at about 8 weeks and was still detectable at 6 months.4
  • Compared with cortisone, gel injections worked more slowly but outperformed cortisone from 8 weeks onward.5
  • In a large network analysis of 137 studies, gel injections had the largest effect on pain among common arthritis treatments compared with oral placebo, although part of this effect is likely due to the injection itself.6
  • A review of US-approved products found them safe and effective through 26 weeks compared with saline.7
  • Repeated courses have been studied for up to 25 months, with sustained pain relief and no increase in side effects.8
  • Compared with anti-inflammatory pills, gel injections gave slightly better pain relief with fewer side effects, particularly stomach problems.9

The honest picture

Large reviews that focus on the biggest, most rigorously blinded trials have found only a small benefit over placebo, smaller than what most patients would notice, along with a slightly higher risk of serious side effects.10,2 The American Academy of Orthopaedic Surgeons does not recommend gel injections for routine use in knee arthritis,11 and the American College of Rheumatology conditionally recommends against them,12 while the international OARSI guideline lists them as an option for some patients.13 In head-to-head studies, PRP has often given greater improvement than gel injections.14,15 Dr. Dold will discuss whether a gel injection is a reasonable choice for you.

1.Who is a good candidate for knee gel injections?

People with mild to moderate knee arthritis whose pain continues despite exercise, weight management and medication, and those who want a non-steroid option or cannot take anti-inflammatory pills.

2.How long do gel injections last?

Benefit usually starts within a few weeks, peaks at about 2 months and may last up to 6 months.4 Some patients have longer relief, and others notice little benefit.

3.Is one injection as good as a series?

Studies disagree. One meta-analysis found that a series of 2 to 4 injections gave the greatest benefit,16 while another found single-injection products worked about as well as multi-injection courses.17 Dr. Dold will recommend a product based on your situation and coverage.

4.Can gel injections be repeated?

Yes. Studies of repeat courses, for example every 6 months, found continued pain relief without additional safety concerns.8

5.Do gel injections delay knee replacement?

Observational studies suggest people who receive gel injections have knee replacement somewhat later,18,19 but these studies cannot prove the injections caused the delay.

6.Do gel injections regrow cartilage?

No. Gel injections can relieve symptoms, but they do not rebuild cartilage or reverse arthritis.

Gel injections for hip arthritis

Dr. Dold also offers gel injections for hip arthritis. Because the hip is deep, he performs hip injections under fluoroscopic (live X-ray) guidance to place the gel accurately inside the joint.

The research for the hip is less favorable than for the knee. A randomized trial found a single gel injection no better than placebo for hip arthritis,20 another found cortisone, but not gel, improved pain compared with saline,21 and a meta-analysis found improvement from baseline but no clear advantage over saline.22 The AAOS strongly recommends against gel injections for hip arthritis,23 and in the U.S. gel products are approved for the knee, so hip use is considered off-label and is often not covered by insurance. Some patients still choose to try it, and Dr. Dold will discuss the evidence and alternatives, including PRP for hip pain, which outperformed gel injections in a hip arthritis trial.24

7.Why is X-ray guidance used for hip injections?

The hip joint sits deep beneath muscle, so live X-ray guidance helps confirm the needle is inside the joint before the gel is injected.

8.Will insurance cover a hip gel injection?

Often not, because gel products are approved for the knee and hip use is off-label. Please call 469-850-0680 to check your coverage and the cost.

Gel vs cortisone vs PRP

CortisoneGel (hyaluronic acid)PRP
OnsetDaysA few weeksA few weeks
Typical durationShort term; better than gel at 2 weeks5Peaks at about 8 weeks, some effect to 6 months4Often 6 to 12 months in studies14,25
Main concernsCartilage loss and faster arthritis progression with repeated use;26,27 blood sugar rises in diabetes28Temporary swelling; occasional inflammatory flare29Temporary soreness for a few days30
InsuranceUsually coveredOften covered for the kneeUsually not covered31
9.Is a gel injection better than a cortisone shot?

They work differently. Cortisone usually works faster, while gel injections take a few weeks but outperformed cortisone after about 8 weeks in a meta-analysis.5 Gel injections do not contain a steroid, so they avoid the blood sugar rise and cartilage concerns linked to repeated cortisone.28,26

10.Gel or PRP: which is better?

Several meta-analyses found PRP gave greater improvement than gel injections in knee arthritis,14,15 but gel injections are more often covered by insurance. Dr. Dold will help you weigh the options.

What to expect

  • Knee: done in the office. Any excess fluid may be drained first, and the gel is then injected into the joint.
  • Hip: done under fluoroscopic (X-ray) guidance to confirm placement.
  • Series products are given as several injections, usually a week apart; single-injection products are given once.
  • Afterward: avoid strenuous activity, such as running or heavy lifting, for a day or two. Temporary pain, warmth or mild swelling may occur and usually settles with ice.
11.What are the side effects of gel injections?

The most common are temporary pain, warmth or swelling at the injection site. Occasionally a stronger inflammatory flare occurs, more often with repeat injections of certain products.29,1 Reviews of the largest trials found a small increase in serious adverse events compared with placebo,2,10 while a review of US-approved products found no significant difference.7

12.I have an egg or bird allergy. Can I have a gel injection?

Some products are made from rooster combs (avian-derived) and others by bacterial fermentation. If you have an allergy to eggs, feathers or poultry, tell Dr. Dold so he can choose a non-avian product.

13.Should I avoid gel injections before a knee replacement?

Yes, if surgery is planned. A study of more than 58,000 knee replacements found that both gel and cortisone injections within 3 months before surgery were linked to a higher infection risk.32

Insurance and scheduling

14.Does insurance cover gel injections?

For the knee, Medicare and many insurers cover gel injections when their coverage criteria are met, and our office can check your plan’s requirements. Dr. Dold accepts most major insurance plans, including Medicare and Tricare; please call 469-850-0680 to confirm your coverage.

15.How do I schedule?
Request an appointment online or call 469-850-0680. Walk-in visits are welcome Monday, Wednesday and Friday, 8:30 to 10:30 am.
Why see Dr. Dold
  • Board certified by the American Board of Orthopaedic Surgery, with subspecialty certification in Sports Medicine
  • Sports medicine and arthroscopy fellowship at NYU Langone / Hospital for Joint Diseases; orthopedic residency at the University of Toronto
  • Fellow of the American College of Surgeons (FACS), the American Academy of Orthopaedic Surgeons (FAAOS), the American Orthopaedic Association (FAOA) and the Royal College of Surgeons of Canada (FRCSC)
  • Has cared for professional and Olympic athletes from the NFL, NBA, NHL, MLS, PGA Tour, Major League Rugby and USA Gymnastics

Research cited on this page

  1. Altman RD, Bedi A, Karlsson J, et al. Product Differences in Intra-articular Hyaluronic Acids for Osteoarthritis of the Knee. Am J Sports Med. 2016. PubMed
  2. Pereira TV, Jüni P, Saadat P, et al. Viscosupplementation for knee osteoarthritis: systematic review and meta-analysis. BMJ. 2022. PubMed
  3. Bellamy N, Campbell J, Robinson V, et al. Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2006. PubMed
  4. Bannuru RR, Natov NS, Dasi UR, et al. Therapeutic trajectory following intra-articular hyaluronic acid injection in knee osteoarthritis--meta-analysis. Osteoarthritis Cartilage. 2011. PubMed
  5. Bannuru RR, Natov NS, Obadan IE, et al. Therapeutic trajectory of hyaluronic acid versus corticosteroids in the treatment of knee osteoarthritis: a systematic review and meta-analysis. Arthritis Rheum. 2009. PubMed
  6. Bannuru RR, Schmid CH, Kent DM, et al. Comparative effectiveness of pharmacologic interventions for knee osteoarthritis: a systematic review and network meta-analysis. Ann Intern Med. 2015. PubMed
  7. Strand V, McIntyre LF, Beach WR, et al. Safety and efficacy of US-approved viscosupplements for knee osteoarthritis: a systematic review and meta-analysis of randomized, saline-controlled trials. J Pain Res. 2015. PubMed
  8. Altman R, Hackel J, Niazi F, et al. Efficacy and safety of repeated courses of hyaluronic acid injections for knee osteoarthritis: A systematic review. Semin Arthritis Rheum. 2018. PubMed
  9. Miller LE, Fredericson M, Altman RD. Hyaluronic Acid Injections or Oral Nonsteroidal Anti-inflammatory Drugs for Knee Osteoarthritis: Systematic Review and Meta-analysis of Randomized Trials. Orthop J Sports Med. 2020. PubMed
  10. Rutjes AW, Jüni P, da Costa BR, et al. Viscosupplementation for osteoarthritis of the knee: a systematic review and meta-analysis. Ann Intern Med. 2012. PubMed
  11. American Academy of Orthopaedic Surgeons. Management of Osteoarthritis of the Knee (Non-Arthroplasty): Evidence-Based Clinical Practice Guideline, 3rd edition. 2021. Read the guideline (PDF)
  12. Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Rheumatol. 2020. PubMed
  13. Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019. PubMed
  14. Belk JW, Kraeutler MJ, Houck DA, et al. Platelet-Rich Plasma Versus Hyaluronic Acid for Knee Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Am J Sports Med. 2021. PubMed
  15. Oeding JF, Varady NH, Fearington FW, et al. Platelet-Rich Plasma Versus Alternative Injections for Osteoarthritis of the Knee: A Systematic Review and Statistical Fragility Index-Based Meta-analysis of Randomized Controlled Trials. Am J Sports Med. 2024. PubMed
  16. Concoff A, Sancheti P, Niazi F, et al. The efficacy of multiple versus single hyaluronic acid injections: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2017. PubMed
  17. Vincent P. Intra-Articular Hyaluronic Acid in the Symptomatic Treatment of Knee Osteoarthritis: A Meta-Analysis of Single-Injection Products. Curr Ther Res Clin Exp. 2019. PubMed
  18. Berkani S, Courties A, Eymard F, et al. Time to Total Knee Arthroplasty after Intra-Articular Hyaluronic Acid or Platelet-Rich Plasma Injections: A Systematic Literature Review and Meta-Analysis. J Clin Med. 2022. PubMed
  19. Maheu E, Rannou F, Reginster JY. Efficacy and safety of hyaluronic acid in the management of osteoarthritis: Evidence from real-life setting trials and surveys. Semin Arthritis Rheum. 2016. PubMed
  20. Richette P, Ravaud P, Conrozier T, et al. Effect of hyaluronic acid in symptomatic hip osteoarthritis: a multicenter, randomized, placebo-controlled trial. Arthritis Rheum. 2009. PubMed
  21. Qvistgaard E, Christensen R, Torp-Pedersen S, et al. Intra-articular treatment of hip osteoarthritis: a randomized trial of hyaluronic acid, corticosteroid, and isotonic saline. Osteoarthritis Cartilage. 2006. PubMed
  22. Wu B, Li YM, Liu YC. Efficacy of intra-articular hyaluronic acid injections in hip osteoarthritis: a meta-analysis of randomized controlled trials. Oncotarget. 2017. PubMed
  23. American Academy of Orthopaedic Surgeons. Management of Osteoarthritis of the Hip: Evidence-Based Clinical Practice Guideline. 2023. Read the guideline (PDF)
  24. Dallari D, Stagni C, Rani N, et al. Ultrasound-Guided Injection of Platelet-Rich Plasma and Hyaluronic Acid, Separately and in Combination, for Hip Osteoarthritis: A Randomized Controlled Study. Am J Sports Med. 2016. PubMed
  25. Bensa A, Previtali D, Sangiorgio A, et al. PRP Injections for the Treatment of Knee Osteoarthritis: The Improvement Is Clinically Significant and Influenced by Platelet Concentration: A Meta-analysis of Randomized Controlled Trials. Am J Sports Med. 2025. PubMed
  26. McAlindon TE, LaValley MP, Harvey WF, et al. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA. 2017. PubMed
  27. Zeng C, Lane NE, Hunter DJ, et al. Intra-articular corticosteroids and the risk of knee osteoarthritis progression: results from the Osteoarthritis Initiative. Osteoarthritis Cartilage. 2019. PubMed
  28. Choudhry MN, Malik RA, Charalambous CP. Blood Glucose Levels Following Intra-Articular Steroid Injections in Patients with Diabetes: A Systematic Review. JBJS Rev. 2016. PubMed
  29. Pullman-Mooar S, Mooar P, Sieck M, et al. Are there distinctive inflammatory flares after hylan g-f 20 intraarticular injections? J Rheumatol. 2002. PubMed
  30. Riboh JC, Saltzman BM, Yanke AB, et al. Effect of Leukocyte Concentration on the Efficacy of Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis. Am J Sports Med. 2016. PubMed
  31. American Academy of Orthopaedic Surgeons. Platelet-Rich Plasma (PRP) for Knee Osteoarthritis: Technology Overview. 2021. Read the overview (PDF)
  32. Richardson SS, Schairer WW, Sculco TP, et al. Comparison of Infection Risk with Corticosteroid or Hyaluronic Acid Injection Prior to Total Knee Arthroplasty. J Bone Joint Surg Am. 2019. PubMed
Still have questions? Dr. Dold is a board-certified orthopedic sports medicine surgeon who offers gel injections for the knee and fluoroscopically guided injections for the hip, along with PRP and BMAC. Request an appointment or call 469-850-0680. Walk-in visits are welcome Monday, Wednesday and Friday, 8:30–10:30 am, at 6700 Dallas Parkway, Suite 100, Frisco.

Medically reviewed by Andrew P. Dold, MD, FAOA, FAAOS, FACS, FRCSC. Last reviewed October 2026. This page is general information, not medical advice. Results vary, and no outcome can be promised.

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Same-day appointments available. Dr. Dold accepts most major insurance plans, including Medicare and Tricare. Please call 469-850-0680 to confirm your coverage.

Request an AppointmentCall 469-850-0680