Last reviewed: September 29, 2026

Yes. A past gel injection does not rule out a knee replacement. As with cortisone, the question is timing.

Gel injections, also called hyaluronic acid or viscosupplementation, go into the same joint that may later be replaced. Studies from large insurance databases found that a gel shot given shortly before surgery was linked to a higher rate of infection in the new joint. How short that window is differs between studies: within one month in some, within two or three months in others. Beyond three months, no added risk has been found.

When studies compared gel and cortisone directly, neither shot carried clearly more risk than the other.

The evidence has limits. It comes from records, not trials, so it shows a link rather than proof of cause. A large study of Medicare patients found no link at all, even for shots within four months of surgery.

In general:

  • Tell your surgeon about any gel shot in that knee, and when it was given.
  • If surgery is already scheduled, ask before getting another gel shot.
  • Several gel shots given well before surgery have not been linked to more infection.

Drafted with AI assistance from published sources, reviewed and edited by Babak Sheikh, MD.

Sources:

  • Richardson SS, et al. Comparison of Infection Risk With Corticosteroid or Hyaluronic Acid Injection Prior to Total Knee Arthroplasty. J Bone Joint Surg Am. 2019. https://doi.org/10.2106/JBJS.18.00454
  • Jones CM, et al. Hyaluronic Acid Injections Administered Within Two Months Prior to Total Knee Arthroplasty Increase the Risk for Periprosthetic Joint Infection. The Knee. 2025. https://doi.org/10.1016/j.knee.2024.12.003
  • Bains SS, et al. Delaying Total Knee Arthroplasty More Than 4 Weeks After Intra-Articular Knee Injection Does Not Further Decrease Risk of Septic Revision. J Knee Surg. 2022. https://doi.org/10.1055/s-0042-1757596
  • Avila A, et al. Intra-Articular Injection Receipt Within 3 Months Prior to Primary Total Knee Arthroplasty Is Associated With Increased Periprosthetic Joint Infection Risk. Knee Surg Sports Traumatol Arthrosc. 2022. https://doi.org/10.1007/s00167-022-06942-3
  • Kurtz SM, et al. Intra-Articular Corticosteroid or Hyaluronic Acid Injections Are Not Associated With Periprosthetic Joint Infection Risk Following Total Knee Arthroplasty. J Knee Surg. 2022. https://doi.org/10.1055/s-0040-1721128
  • Khan IA, et al. Cumulative Intraarticular Injections Are Not a Risk Factor for Periprosthetic Joint Infection Following Total Knee Arthroplasty. J Arthroplasty. 2022. https://doi.org/10.1016/j.arth.2022.02.027

This is general information about what published research shows. It is not medical advice and it is not about your situation. Reading it does not create a doctor-patient relationship with me. I am a retired orthopedic surgeon and I do not see patients. Talk with your own doctor before changing anything about your care. If something feels suddenly or seriously wrong, get medical care promptly rather than waiting.

This page is provided as is. I make no guarantee that it is accurate, complete or current, and medical evidence changes. Use of it is at your own risk.

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