Last updated: October 17, 2014
Trade Names: Hyalgan, Monovisc, Orthovisc, Synvisc, Synvisc-One, Supartz
Synonyms: Viscosupplements, hyaluronic acid
Drug Class: Viscosupplement
Hyalgan 2ml (avian)
Monovisc 4 ml (bacterial)
Orthovisc 2 ml (bacterial)
Synvisc 2 ml (avian)
Synvisc-One 6 ml (avian)
Dose (for OA of the knee)
Hyalgan 2ml (20 mg) intra-articular injection once weekly for 5 weeks
Monovisc 4ml (88 mg) intra-articular injection once
Orthovisc 2ml (30 mg) intra-articular injection once weekly for 3-4 weeks
Synvisc 2ml (16 mg) intra-articular injection once weekly for 3 weeks
Synvisc-One 6ml (48 mg) intra-articular injection once
Indications: Osteoarthritis of the knee
Mechanism of Action: Unknown; initially thought to improve viscosity of synovial fluid but because the duration of clinical effects can far exceed the time the drug is present in the joint, other mechanisms of action are likely.
Contraindications: Hypersensitivity to hyaluronate or any component of the formulation (some preparations avian source, some bacterial)
Precautions: Strict aseptic technique, do not inject extra-articularly
Pregnancy Risk: Unknown
Common: Pain and swelling in the injected knee
Less common: Rash, flushing, hypersensitivity
Comments: Most trials have found efficacy greater than placebo but quality of trials has been poor with true double-blinding difficult due to the viscosity of the injection. Controversial whether there is a clinically relevant effect. Injection reactions in the treated knee are usually minor but can resemble septic arthritis.
Rutjes AW, Jüni P, da Costa BR, et al. Viscosupplementation for osteoarthritis of the knee: a systematic review and meta-analysis. Ann Intern Med 2012;157:180-91 PMID: 22868835.