Osteoarthritis (OA) is the fastest growing major health condition with symptomatic disease affecting approximately 46 million people in the US. Hyaluronic acid gives synovial fluid the viscous quality that helps to lubricate and absorb shock. Joints affected by OA have poorer quality and less hyaluronic acid in the joint fluid. Viscosupplementation--the injection of a synthetic version of hyaluronic acid into joints such as knees, shoulders, and hips--is thought to improve the viscosity of synovial fluid, resulting in smoother movement and reduced pain. FDA and non-FDA approved indications for various viscosupplements in the management of pain related to OA will be discussed. We will also present existing medical literature and pragmatic recommendations for the use of viscosupplementation for the management of symptomatic OA in large synovial joints.