Cingal Injections

When Might Cingal Be Considered?

Cingal may be considered for selected people with knee osteoarthritis when pain, stiffness or inflammation is significantly affecting walking, exercise, work or everyday activity.

It may be an option when appropriate rehabilitation, activity modification or pain relief has not provided sufficient improvement, and when both an anti-inflammatory effect and hyaluronic-acid treatment are considered clinically appropriate.

The decision is not based on an X-ray or MRI result alone. Your specialist will consider your symptoms, clinical findings, degree of joint irritability, previous treatment, medical history and personal goals before advising whether Cingal is a reasonable option.

How Is Cingal Different From Other Injections?

Corticosteroid injections contain an anti-inflammatory medicine but do not contain hyaluronic acid. Durolane and Ostenil Plus contain hyaluronic acid but do not contain corticosteroid.

Cingal combines both components within one injection. The corticosteroid is intended to address inflammatory symptoms, while the hyaluronic acid supplements the lubricating and shock-absorbing properties of the synovial fluid.

This does not mean Cingal is automatically more effective or more appropriate than the other options. Because it contains corticosteroid, the medical considerations and potential risks associated with steroid treatment must also be taken into account.

Specialist Assessment Comes First

Every Cingal enquiry is reviewed by a physiotherapist with specialist expertise in knee osteoarthritis.

Before arranging an appointment, we will contact you by telephone or video to discuss your symptoms, medical history, medication, previous treatment and any imaging you have already had.

An in-person clinical assessment is then completed before treatment. If Cingal remains appropriate, the injection can proceed following a full discussion of the potential benefits, limitations and risks. If another injection, investigation or treatment approach would be more suitable, your specialist will explain the recommended next step.

See How the Injection Process Works →

Do I Need Imaging Before a Cingal Injection?

Not everyone requires new imaging. Existing X-rays or scans can be reviewed alongside your symptoms and clinical findings, but imaging changes do not always correspond directly with pain or function.

Your specialist may recommend an X-ray or other investigation when it would help confirm the diagnosis, assess the joint or influence the choice of treatment.

Our service provides specialist clinically guided injections rather than ultrasound-guided injections. If ultrasound guidance would be preferable, we will recommend appropriate onward referral.

Who May Not Be Suitable?

Cingal should not be injected when there is an infection within the knee, an active infection or skin problem around the proposed injection site, or a known allergy to hyaluronic acid, triamcinolone or another component of the injection.

Additional consideration is required for people with diabetes, those taking anticoagulant medication, anyone with a bleeding disorder, people who are pregnant or breastfeeding, and those who have recently received another corticosteroid injection.

It is also important to discuss any planned surgery or knee replacement, as the timing of a corticosteroid-containing injection may affect when surgery can safely proceed.

These circumstances do not all automatically prevent treatment, but they must be discussed before an appointment is arranged.

Potential Risks and Side Effects

Temporary pain, stiffness, warmth or swelling can occur after a Cingal injection. Symptoms may briefly feel worse before settling.

Bruising or bleeding around the injection site can also occur. The corticosteroid component may cause facial flushing, sleep or mood disturbance, menstrual disturbance or a temporary rise in blood glucose.

Less common complications include skin discolouration, thinning of the skin or fatty tissue around the injection site, a more pronounced inflammatory reaction within the knee, infection, allergic reaction, nerve injury or damage to surrounding structures.

Serious complications are uncommon, but no injection is risk-free. Your individual risks will be discussed before consent is obtained, together with advice about symptoms that require urgent medical attention.

What Happens After the Injection?

You will receive aftercare advice based on your symptoms, usual activities and rehabilitation needs. A short period of relative rest is generally recommended before walking, exercise and rehabilitation are gradually resumed.

The corticosteroid component may begin influencing symptoms earlier than hyaluronic acid alone, while the response to the hyaluronic-acid component may develop more gradually. This pattern is not the same for everyone.

The degree and duration of improvement vary, and some people experience little or no meaningful benefit. A particular outcome or length of symptom relief cannot be guaranteed.