Marc Darrow MD, JD. Thank you for reading my article. You can ask me your questions about  this article using the contact form below. 

This is a very frequent question that I get via email.

  • “Can I get a Synvisc or other type of hyaluronic acid injection while I get stem cell therapy treatments?”
  • Our answer is, this is not something we do, we do not offer hyaluronic acid injections.
  • In this article you will see that  research suggests that one of the healing factors of stem cell therapy is its ability to stimulate the production of naturally occurring Hyaluronic acid and enhance the viscosity and thickness of your own synovial joint fluid. Therefore, synvisc injection after stem cell treatment or in between stem cell treatments is not something we would generally recommend.

While some debate whether to get hyaluronic acid injections or stem cell injections. Research suggests that stem cells can provide the stimulus to creating more natural Hyaluronic acid

Hyaluronic acid is a naturally occurring substance that is a major component of the protective synovial fluid that surrounds the knee. In its natural form it is also a key component of wound healing. In its processed form used for injection purposes, hyaluronic acid is NOT a key healing component as attested to by suggestions and recommendations that these injections are stop gaps until knee replacement can be performed.

While some debate whether to get hyaluronic acid injections or stem cell injections. Research suggests that stem cells can provide the stimulus to creting more natural Hyaluronic acid

Over the years we have seen many patients who are looking to continue non-surgical treatment options for their bone-on-bone knees after they have “used up,” all of their Hyaluronic acid shots.

As many of you know first-hand, Hyaluronic acid injections, commonly known as Euflexxa®, Supartz®, Supartz FX®, Hyalgan®, Synvisc®, HYMOVIS®etc, is an attempt to restore the knee’s synovial fluid’s lubrication properties through viscosupplementation and restoration of  lost hyaluronic acid levels. These injections can not be given over long periods of time as their effect dwindles to the point of providing no benefit. This is outlined in the medical research.

  • Published research in the Annals of internal medicine noted that in patients with knee osteoarthritis, viscosupplementation offered a small and clinically irrelevant benefit and an increased risk for serious adverse events.
    • The primary outcomes of this study were pain intensity and flare-ups.
    • Secondary outcomes included function and serious adverse events.(1)
  • In another larger study in the French medical publication Prescribe International, researchers found that hyaluronic acid injections only provided a small relief to patients with osteoarthritis of the knee, but agreed that hyaluronic acid injections could provoke both local reactions and serious adverse effects.”(2)
  • In the Annals of rheumatic disease, doctors recently warned that while Hyaluronic acid injections can provide significant pain relief and improvement in the knee – This may cause excessive loading on the knee joints, which may further accelerate the rate of knee degeneration.(3)

Once a patient reaches their “allowable limit Hyaluronic acid injections” his/her doctor will likely send them to surgery because of a progression of their osteoarthritis condition. This is when we get the question, can stem cell therapy help?

Bone marrow derived stem cells help in many ways. One way to “re-hydronate,” the synovial fluid with natural hyaluronic acid.

There is new fascinating research about the inter-relationship between natural hyaluronic acid and stem cell therapy.

  • Medical university researchers in Taiwan examined this relationship between stem cells and hyaluronic acid through the interaction of Bone Marrow derived Mesenchymal Stem Cell injections and the diseased knee environment. Their results indicated that bone marrow derived stem cells when introduced into an arthritic joint change the disease environment to a healing environment by increasing the natural production of hyaluronic acid.(4)
  • This unique relationship between stem cells and hyaluronic acid was also noted by doctors at the University of Leeds in the UK who suggested a spontaneous healing of cartilage in a newly created  “favorable biochemical and biomechanical (knee) environment.(5)


Research like that presented above begs the question:

Why get short lasting viscosupplementation when stem cell therapy can change the healing environment of the knee to produce its own?

Ask Dr. Darrow about your knee pain

A leading provider of bone marrow derived stem cell therapy, Platelet Rich Plasma and Prolotherapy

PHONE: (800) 300-9300

1 Rutjes AWS, Jüni P, MD; da Costa BR, et al. Viscosupplementation for Osteoarthritis of the Knee: A Systematic Review and Meta-analysis. Ann Intern Med. 2012 Jun 11.
2, Intra-articular hyaluronic acid injection: not for gonarthrosis. Prescrire Int. 2013 Oct;22(142):248-9.
3. Tang AC, Tang SF, Hong WH, Chen HC. Kinetics features changes before and after intra-articular hyaluronic acid injections in patients with knee osteoarthritis. Clin Neurol Neurosurg. 2015 Feb;129 Suppl 1:S21-6. doi: 10.1016/S0303-8467(15)30007-X.

4 Chang KV, Hung CY, Aliwarga F, Wang TG, Han DS, Chen WS. Comparative Effectiveness of Platelet-Rich Plasma Injections for Treating Knee Joint Cartilage Degenerative Pathology: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil. 2013 Nov 27. pii: S0003-9993(13)01212-4.
5. Baboolal TG, Mastbergen SC, Jones E, Calder SJ, Lafeber FPJG, McGonagle D. Synovial fluid hyaluronan mediates MSC attachment to cartilage, a potential novel mechanism contributing to cartilage repair in osteoarthritis using knee joint distraction. Annals of the Rheumatic Diseases. 2016;75(5):908-915. doi:10.1136/annrheumdis-2014-206847.
6. Sánchez M, Fiz N, Azofra J, et al A Randomized Clinical Trial Evaluating Plasma Rich in Growth Factors (PRGF-Endoret) Versus Hyaluronic Acid in the Short-Term Treatment of Symptomatic Knee Osteoarthritis. Arthroscopy. 2012 Aug;28(8):1070-8.