hyaluronic acid

Osteoarthritis—“Twinges in all your hinges”


Dr. Aly Abdulla, MD, CCFP, FCFP, DipSportMed CASEM, CTH, CCPE, McPL,1
Neelam Charania, BSc, MSc (OT),2

1 is a family doctor with specialties in sports medicine, palliative care, and cosmetic medicine. He can be found on Twitter, LinkedIn and
2 has a Masters in Occupational Therapy from Boston University and involved in managing and rehabilitating patients with chronic osteoarthritis and disability.


Abstract: Osteoarthritis is most common form of arthritis. It is also very disabling. Fortunately, there is a long list of medical therapies including education, OTC meds, strengthening, braces, prescribed medications, standard and non-standard intra-articular therapies and some new experimental therapies. This article focuses on well known and well proven therapies like cortisone and hyaluronic acid injections into large joints like knees and hips. Large meta-analysis shows improvement in pain, physical function and stiffness in a simple well tolerated procedure with minimal side effects.
Key Words: osteoarthritis, arthritis, knee, hip, joint injections, steroid, hyaluronic acid.
OA symptoms include joint pain, morning stiffness <30min, reduced ROM, and possibly swelling.
The most common joints are knees, hips, fingers, thumbs, big toes and lumbar spine.
The key pathophysiology in OA is destruction of cartilage and bone formation, which reduces function and causes pain.
Simple x-rays are diagnostic. There is no need for advanced imaging like CT or MRI for OA.
A combination of therapy is key to successfully managing this condition.
If morning stiffness >30 minutes, stiffness and pain increases with rest, joint warmth or erythema, or three or more joints, you should think of inflammatory, septic, or crystal arthritis RATHER than osteoarthritis.
Don't forget about weight loss, bracing, topical agents, or non conventional medications like duloxetine or tramadol in osteoarthritis.
There is no maximum amount of cortisone injections in a joint but it is mainly used for stiffness, swelling and pain.
Hyaluronic acid intra articular injections manage symptoms of pain, stiffness, range of motion, and physical function. The best formulations are high MW and cross-linked because they last longer.
New experimental therapies like PRP, MSC, and ACI have limited evidence and are costly.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Disclaimer at the end of each page