Key facts
- What it is: viscosupplementation — injecting hyaluronic acid into a joint to restore lubrication and cushioning lost through osteoarthritis.
- What we use: including Euflexxa (1% sodium hyaluronate), a TGA-approved viscosupplement, typically given as a short course of weekly injections.
- Versus corticosteroid: corticosteroid acts faster in the first couple of weeks, but hyaluronic acid has shown comparable or better pain relief from around six weeks onward, with a more favourable long-term safety profile.
- How it's delivered: under image guidance, so the injection is confirmed to be precisely within the joint space.
Hyaluronic acid injections — viscosupplementation — replace some of the natural joint lubricant lost as osteoarthritis progresses. Hyaluronic acid is a normal component of healthy joint fluid, giving it its cushioning and lubricating properties; as osteoarthritis develops, both the quantity and quality of this fluid decline, contributing to stiffness and pain.
Euflexxa and other hyaluronic acid preparations
Among the hyaluronic acid preparations available, Euflexxa (1% sodium hyaluronate) is TGA-approved for knee osteoarthritis and has one of the more established evidence bases among viscosupplements, including a saline-controlled randomised trial (the FLEXX trial) supporting its efficacy and safety. It's typically given as a short course of weekly intra-articular injections.
How it compares with corticosteroid injection
Corticosteroid injections are still widely used for osteoarthritis flares because they act quickly — often within days. But that fast relief tends to fade within a matter of weeks, and repeated corticosteroid injections have raised some concern in the literature around cartilage and soft tissue effects with frequent, long-term use.
What recent studies show: several comparative trials — including a 2025 randomised comparative study of intra-articular hyaluronic acid versus corticosteroid in knee osteoarthritis — found that while both groups improved significantly, the hyaluronic acid group showed superior pain reduction and functional improvement from six weeks onward, with significantly better outcomes at three months.
Safety considerations: hyaluronic acid does not carry the blood glucose effects seen with corticosteroid, making it a reasonable option for patients with diabetes, and current osteoarthritis management guidance (ESCEO) has flagged safety concerns with frequent corticosteroid use while continuing to support hyaluronic acid as a safe option within a stepwise treatment approach.
Put simply: corticosteroid may still be the better choice for a rapid flare requiring quick relief, but for sustained benefit over weeks to months, the evidence increasingly favours hyaluronic acid — including TGA-approved products like Euflexxa — as being as good as, or better than, corticosteroid for that purpose.
Who it suits
- Mild-to-moderate knee osteoarthritis, particularly where a longer-lasting effect than corticosteroid is the goal
- Patients with diabetes, where avoiding corticosteroid's glucose effects is preferable
- Patients wanting to space out or avoid repeated corticosteroid exposure
Common questions
What is Euflexxa?
Euflexxa is a TGA-approved, 1% sodium hyaluronate viscosupplement used to treat knee osteoarthritis pain, typically given as a short course of weekly injections into the knee joint.
Is hyaluronic acid better than cortisone for knee osteoarthritis?
Corticosteroid tends to work faster in the first couple of weeks, but several studies show hyaluronic acid providing comparable or superior pain relief from around six weeks onward and out to three months, with a better long-term safety profile with repeated use.
How many hyaluronic acid injections are needed?
This depends on the specific product used — some are given as a single injection, while others, including Euflexxa, are typically given as a short course of weekly injections.
Is hyaluronic acid safe for people with diabetes?
Yes — unlike corticosteroid injections, which can transiently raise blood glucose, hyaluronic acid does not have this effect, making it a reasonable option for patients with diabetes.
Next step
Wondering if viscosupplementation applies to you?
Ask your GP about a referral, or get in touch directly to discuss suitability.
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