Knee osteoarthritis (OA) is a prevalent and often debilitating degenerative joint disease that significantly impacts the mobility and quality of life for millions worldwide. While conservative measures form the first line of treatment, many patients experience persistent pain and functional limitations. Intra-articular hyaluronic acid (HA) injections, a therapy known as viscosupplementation, offer a valuable option for providing symptomatic relief in such cases.

Hyalgan® (sodium hyaluronate), manufactured by Fidia Farmaceutici, is a well-established, first-generation HA viscosupplement. Derived from natural rooster combs, it has a long history of clinical use and is recognized globally for its role in managing knee OA symptoms through a multi-injection regimen. This article provides a comprehensive clinical overview of Hyalgan®, detailing its composition, mechanism of action, established indications for knee OA, its typical multi-injection protocol, clinical efficacy, and crucial safety considerations for practitioners.

(This guide is intended for trained medical professionals experienced in intra-articular injection techniques. Adherence to local regulations and the product’s instructions is mandatory. This information does not substitute for specific product training.)

Hyalgan®: Composition and Key Characteristics

Hyalgan® is a sterile, pyrogen-free, viscoelastic solution primarily composed of:

• Active Ingredient: Sodium Hyaluronate (a high molecular weight fraction of purified hyaluronic acid). The typical concentration is 10mg/mL, supplied in a 2mL prefilled syringe.
• Source: A crucial characteristic of Hyalgan® is that its hyaluronic acid is derived from natural rooster combs (avian source). This biological origin necessitates careful patient screening for avian-related allergies (see Contraindications).
• Mechanism: Hyalgan® functions primarily through viscosupplementation, aiming to restore the rheological properties of the synovial fluid within the osteoarthritic knee.

Mechanism of Action: How Hyalgan® Provides Symptomatic Relief

In an osteoarthritic joint, the synovial fluid, which normally lubricates and cushions the joint, is often reduced in quantity and quality (lower HA concentration and molecular weight). This leads to increased friction, pain, and inflammation. Hyalgan® addresses this by:

1. Restoring Synovial Fluid Properties: When injected intra-articularly, Hyalgan® supplements the native HA, restoring the viscoelastic properties of the synovial fluid.
2. Lubrication: The injected HA acts as a lubricant, reducing friction between the articular cartilage surfaces during joint movement.
3. Shock Absorption: It enhances the shock-absorbing capacity of the synovial fluid, protecting the cartilage from impact forces.
4. Potential Secondary Effects: While the primary mechanism is mechanical and viscoelastic, some evidence suggests HA may also have secondary biological effects, such as mild anti-inflammatory actions or interactions with joint tissues that contribute to pain relief.

By restoring these crucial functions of the synovial fluid, Hyalgan® aims to reduce pain and improve joint function in patients with knee OA.

Clinical Applications & Patient Selection (Knee OA Indication)

Hyalgan® is globally indicated for the treatment of pain associated with osteoarthritis (OA) of the knee.

• Target Patient Profile: It is generally recommended for patients with mild to moderate knee OA experiencing pain, particularly those who have had an inadequate response to conservative non-pharmacologic therapies (e.g., physical therapy, exercise, weight loss) and simple analgesics (e.g., acetaminophen, NSAIDs).
• Contraindications: Practitioners must thoroughly screen patients for contraindications, which typically include:
  • Known hypersensitivity to hyaluronan preparations or avian-derived products (such as feathers, eggs, or poultry). This is a critical screening point due to the product’s source.
  • Presence of active knee joint infections or skin diseases/infections in the area of the intended injection site.
  • Significant joint effusion (excess fluid in the knee). If present, arthrocentesis (aspiration of the effusion) should be performed prior to Hyalgan® injection.
• Untested Populations: As with many intra-articular therapies, Hyalgan® has not been extensively tested in pregnant or lactating women, or in individuals under 18 years of age. Its use in these populations should be carefully considered and is generally not recommended unless potential benefits clearly outweigh risks.

Administration Protocol: The Multi-Injection Regimen

The established administration protocol for Hyalgan® is a key aspect of its clinical use:

• Dosing Schedule: Hyalgan® is typically administered as one 2mL intra-articular injection into the knee joint once a week, for a total of three to five injections. The 5-injection series is common and often provides more sustained relief for many patients, though some protocols or patient responses may warrant a 3-injection series.
• Aseptic Technique: Strict aseptic technique is absolutely mandatory for all intra-articular injections to prevent the devastating complication of septic arthritis. This includes thorough skin preparation of the injection site with an appropriate antiseptic, use of sterile gloves, and ensuring sterility of the syringe and needle throughout the procedure.
• Injection Procedure: The injection should be performed by a medical professional trained in intra-articular knee injection techniques. Standard portals (e.g., superolateral, anterolateral) may be used. If joint effusion is present, it should be aspirated before Hyalgan® is injected. A new sterile syringe and needle must be used for each knee if treating bilaterally.
• Post-Injection: Patients are typically advised to avoid strenuous or weight-bearing activities for approximately 48 hours after each injection.

Clinical Efficacy & Patient Outcomes

Extensive clinical use and numerous studies over decades have established the efficacy of Hyalgan® for symptomatic relief of knee OA.

• Pain Reduction: Hyalgan® has been shown to significantly reduce knee OA pain compared to placebo or saline injections.
• Functional Improvement: Many patients experience an improvement in joint mobility and overall function, allowing for better performance of daily activities.
• Onset and Duration: The onset of pain relief is often gradual, typically becoming more noticeable after the full course of injections (3-5 weeks). The duration of effect is variable but commonly lasts for approximately 6 months, after which the treatment course can be repeated if deemed appropriate.

It is important to manage patient expectations, explaining that Hyalgan® provides symptomatic relief and aims to improve quality of life but is not a cure for osteoarthritis.

Safety Profile & Potential Side Effects

Hyalgan® is generally well-tolerated when administered correctly by trained professionals and after appropriate patient screening (especially for avian allergies).

• Common Adverse Events: Most side effects are mild, transient, and related to the injection site. These include:
  • Pain, tenderness, or discomfort at the injection site
  • Swelling or joint effusion
  • Warmth or redness
  • Bruising
  • Itching
• Avian Allergy Risk: Due to its rooster comb origin, there is a potential for allergic reactions in individuals with hypersensitivity to avian proteins, eggs, or feathers. Thorough screening is vital.
• Serious Risks (Though Rare):
  • Septic Arthritis: This is the most significant and potentially devastating complication of any intra-articular injection. It is caused by bacterial contamination during the procedure. Strict adherence to aseptic technique is the primary preventative measure. Symptoms include acute onset of severe joint pain, significant swelling, warmth, fever, and inability to bear weight. Immediate medical evaluation and treatment are critical.
  • Hypersensitivity/Allergic Reactions: Can range from mild local reactions to, very rarely, systemic reactions.
  • Acute Inflammatory Reactions (Pseudo-sepsis): A non-infectious, acute inflammatory response in the joint can occasionally occur.

Practitioners must consult the complete product guidelines and literature specific to their region for comprehensive safety information, warnings, and precautions.

Sourcing Authentic Hyalgan®

Ensuring patient safety and treatment efficacy hinges on the use of genuine, properly stored medical products. It is crucial for practitioners to:

• Source Hyalgan® only from reputable, established B2B medical suppliers like Health Supplies Plus.
• Verify product packaging, labeling, lot numbers, and expiry dates to ensure authenticity and integrity.
• Understand the risks associated with counterfeit or improperly handled intra-articular injectables, which can lead to severe adverse events or lack of efficacy.

Conclusion

Hyalgan® remains a significant and well-established option in the viscosupplementation armamentarium for managing symptomatic knee osteoarthritis. Its rooster comb-derived hyaluronic acid, administered via a series of 3 to 5 weekly intra-articular injections, aims to restore synovial fluid properties, thereby reducing pain and improving joint function.

Successful and safe outcomes with Hyalgan® depend critically on meticulous patient screening (particularly for avian allergies), strict adherence to aseptic injection techniques, proper administration of the multi-injection protocol, and the use of authentic product sourced from reliable channels according to local regulations. By integrating these principles, practitioners can effectively leverage Hyalgan® to improve the quality of life for appropriate patients suffering from knee OA.

Doris Dickson

About the Author: Doris Dickson is a specialist writer for Health Supplies Plus, focusing on the aesthetic medicine industry. She diligently researches cosmetic treatments and products to provide clear, concise information relevant to licensed medical professionals. Her work supports Health Supplies Plus’s commitment to being a reliable informational resource and trusted supplier for the aesthetic community.

 

Disclaimer: The content provided in this article is intended for informational purposes only and is directed towards licensed medical professionals. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment, nor does it constitute an endorsement of any specific product or technique. Practitioners must rely on their own professional judgment, clinical experience, and knowledge of patient needs, and should always consult the full product prescribing information and relevant clinical guidelines before use. Health Supplies Plus does not provide medical advice.