Hyaluronic Acid Injections

What is hyaluronic acid?

Hyaluronic acid is a naturally occurring substance that is a primary element of the extracellular matrix (ECM). The components of the ECM link together to form a structurally stable composite, contributing to the mechanical properties of tissue. Hyaluronic acid is a key ingredient found in the fluid that lubricates the joints (synovial fluid) and protects the cells that form articular cartilage. Hyaluronic acid can play an important role in decreasing inflammation as well as providing  a hospitable environment to regenerate damaged tissue.

What is a hyaluronic gel injection?

Hyaluronic acid is mixed with water which causes it to thicken into a gel-like substance which can be directly administered into the joint. Also called viscosupplementation, this treatment alternative is often used when conservative therapy has been unsuccessful and the patient doesn’t want to undergo surgery. Hyaluronic injections can, in some cases, put off surgery all together. Dr. Prem Ramkumar, orthopedic joint preservation doctor, is located in Long Beach and serves patients in Los Angeles, Orange County, and surrounding Southern California areas who can benefit from hyaluronic gel injections.

Is Hyaluronic acid or gel treatments FDA approved?

Yes! Hyaluronic treatments have been approved for joint injections for several years and have shown to be effective in certain patients. Talk to Dr. Ramkumar to see if you are a candidate.

Are there different treatment options for hyaluronic acid therapy?

There are several commercially available viscosupplementation preparations of hyaluronic acid. Dr. Ramkumar will consider the patient’s age, activity level, medical history, and desired outcome. Currently, Dr. Ramkumar prefers the following brands:

Durolane:

Approved by the FDA in 2017, Durolane is made by Boventus, a global leader in orthobiologics. DUROLANE is hyaluronic acid injection therapy for mild-to-moderate osteoarthritis designed to provide powerful and long-lasting pain relief.

OrthoVisc:

Approved by the FDA since 2004, OrthoVisc is made from ultra-pure hyaluronan, a naturally occurring lubricant found in healthy knee joints. This knee pain injection boasts pain relief up to six months. OrthoVisc does not come from avian sources and is particularly recommended for those with avian allergies.

Why don’t I have a steroid injection instead of a gel or hyaluronic acid?

As a physician focused on preserving your native joint, Dr. Ramkumar rarely performs steroid injections. Studies have time and time again demonstrated that steroids injected into the knee actually kill cartilage and reduce its overall available volume, thereby accelerating or causing worsened arthritis. In a randomized clinical trial by McAlindon et al. in JAMA, patients with symptomatic knee osteoarthritis who underwent steroid injection (compared to plain saline injections) had significantly greater cartilage volume loss with no significant difference in knee pain two years later. In the American Journal of Sports Medicine, Wesdorp et al. showed using a mouse model that steroid injections temporary reduce inflammation while simultaneously inhibiting cartilage repair mechanisms.

Will my insurance pay for hyaluronic gel injections?

Insurance can be tricky and the answer is “sometimes.” Insurance companies in our state are often slow to pay for or approve hyaluronic treatments. Many of Dr. Ramkumar’s patients prefer to order and pay for their injections themselves. If you are interested in this click on the button below for ordering options:

How does it work when I get my own hyaluronic gel injections?

The process is simple. If Dr. Ramkumar agrees you are a candidate for a gel injection after an initial evaluation, you will then order and pay for your injections. When they arrive, make an appointment to come in to see Dr. Ramkumar. He will inject the gel exactly where needed in his office.  This is a reliable option if you do not have insurance, do not want to use or wait for your insurance, or if your insurance has denied the injection.

What are the risks of gel injections?

The risks of a gel injection are overall minimal. However, any procedure entering a joint carries the risk of an infection, although this is extremely rare after an in-office gel injection.

How often can I receive a gel injection?

Dr. Ramkumar prefers to space these injections apart by at least three to six months. In rare cases – such as the performance of an in-season professional athlete or the postoperative maintenance of a cartilage transplant – would this be potentially reconsidered.