About Hyaluronate Injections in Your Knee

This information explains what to expect after your hyaluronate (Hymovis^®, Orthovisc^®, Euflexxa^®) injections (shots) in your knee.

About Hyaluronate Injections

Hyaluronate is a medication that’s used to treat knee pain caused by osteoarthritis. Osteoarthritis is a disease in which the cartilage (protective tissue at the ends of bones) of your joint wears down. This can lead to pain and swelling.

Hyaluronate is used when you still have pain after trying other treatments for osteoarthritis. This medication is injected into your joint and should help with the pain when you move.

Most people get the injections once a week for 2 to 5 weeks in a row, depending on which medication your doctor is using. The pain relief from hyaluronate injections may last from several weeks to a few months.

For more information about your injection, ask your nurse for the resource Hyaluronate and Derivatives.

Before Your Procedure

Before your injection, tell your doctor if you:

• Have an allergy to latex or any medications.
• Have an infection near your knee joint where the injection will be given.
• Are currently receiving chemotherapy.
• Are taking any of the following medications:
  • Aspirin or medications that contain aspirin
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil^®, Motrin^®) or naproxen (Aleve^®)
  • Medications that prevent blood clots, such as warfarin (Coumadin^®), clopidogrel (Plavix^®), enoxaparin (Lovenox^®), rivaroxaban (Xarelto^®), dabigatran (Pradaxa^®), apixaban (Eliquis^®), or heparin

During Your Procedure

The first time you get your hyaluronate injection, you will need to sign a consent form (form that says you agree to the procedure and understand the risks).

Your doctor may do an ultrasound (imaging that uses sound waves to make a picture) to decide where to do the injection. Your doctor will examine your joint and clean the area. Some people may get an injection of local anesthesia (medication that numbs an area) before getting the hyaluronate injection.

During your hyaluronate injection, you should only feel some pinching as the needle is put through your skin and the medication is injected. After the medication is injected, your doctor will remove the needle and clean the injection site. You will have a small bandage (Band-aid^®) placed over the site.

After Your Procedure

• Follow these guidelines after your procedure.

• Keep the injection site dry and keep a clean bandage over the site for 24 hours.
• Don’t take a bath, use a hot tub or sauna, go swimming, or submerge yourself in water for 2 days after your procedure.
• The site may be sore for a few days. Ask your doctor about taking pain medication.
• Ask your doctor if there are any activities or movements that you should avoid, such as standing for long periods, jogging, or lifting heavy objects.
• Don’t use hot or warm packs on the site for 24 hours after your injection.
• Your knee may feel stiff or you may feel a spongy sensation when you walk. This may last for 2 to 3 days.
• You may not feel relief from your knee pain until after your last injection.
• You may apply a cold pack to your knee for 10 to 15 minutes every 4 hours to help with any discomfort.
• After your injection, you may take your usual prescription or over-the-counter (medications you buy without a prescription) pain medication (such as Advil, Aleve, or Tylenol^®) to help with any pain you’re feeling. 
• Don’t put on any creams or topical medications (medications you put on your skin) to the injection site for 24 hours.

Side effects

Side effects are rare. Your knee may feel slightly tender or stiff following the injection. Most people don’t have any other reaction to their hyaluronate injection.

Call 911 if You:

• Have any signs of an allergic reaction such as a rash, red, swollen, blistered, or peeling skin, difficulty breathing, or swelling in your mouth, face, lips or throat.

Call Your Doctor or Nurse if You Have Any of the Following Signs of Infection:

• A fever of 100.4° F (38.3° C) or higher
• Pain at the injection site that doesn’t start to feel better after 48 hours
• Redness or swelling where the shot was given
• Bruising or discoloration where the shot was given
• Warmth in or by your knee
• Back pain
• Muscle pain
• Higher blood pressure than usual
• Nausea (feeling like you’re going to throw up)
• Skin irritation such as rash or itching.
• Any new or unexplained symptoms