A Practitioner's Guide to Orthopedic Injectables & Viscosupplements

Doris Dickson Orthopedic Injectables May 5, 2025

The management of osteoarthritis (OA), particularly in weight-bearing joints like the knee and shoulder, presents a significant clinical challenge. As conservative measures prove insufficient for many patients, intra-articular viscosupplementation with hyaluronic acid (HA) has become a cornerstone of non-surgical pain management, offering a way to improve joint function and delay the need for more invasive procedures.

This comprehensive guide provides a clinical overview of leading orthopedic injectables for medical professionals. We will delve into the science behind viscosupplementation, compare the unique formulations of top brands like Monovisc®, Synvisc®, Durolane®, and Hymovis®, and discuss best practices for administration and patient selection. For licensed practitioners looking to source these essential treatments, view our full selection of orthopedic injectables here.

Understanding Viscosupplementation: The Science and Mechanism

In a healthy joint, the synovial fluid is rich in high molecular weight hyaluronic acid, which provides critical viscoelastic properties—acting as both a lubricant to reduce friction and a shock absorber to cushion the joint. In osteoarthritis, the concentration and quality of this natural HA degrades, leading to increased pain and stiffness.

Viscosupplementation works by injecting exogenous hyaluronic acid directly into the joint space. This therapy aims to:

Restore Lubrication: Supplementing the synovial fluid reduces friction between articular cartilage surfaces, allowing for smoother movement.
Enhance Shock Absorption: The injected HA helps cushion the joint, absorbing mechanical stress during activity.
Restore Viscoelasticity: It helps normalize the fluid dynamics within the joint, contributing to pain reduction and improved function.

Emerging evidence also suggests potential chondroprotective (cartilage-protecting) and anti-inflammatory effects, making it a multi-faceted therapeutic intervention.

Comparing Top Orthopedic Injectable Brands

The market offers several advanced HA formulations, each with distinct characteristics regarding its source, molecular weight, cross-linking, and injection protocol. Understanding these nuances is key to optimal patient selection.

Monovisc® (High Molecular Weight Hyaluronan)

Developed by Anika Therapeutics, Monovisc® is a prominent single-injection viscosupplement known for its convenience and safety profile.

Source & Composition: A key differentiator is its production via bacterial fermentation. This non-avian origin eliminates the risk of hypersensitivity reactions in patients with allergies to eggs, feathers, or poultry. It consists of lightly cross-linked, high molecular weight sodium hyaluronate.
Protocol: A single 4mL intra-articular injection.
Duration: Clinical studies demonstrate pain relief and functional improvement for up to 6 months.
Best For: Patients who prefer the convenience of a single-injection regimen or have known avian allergies.

Synvisc® & Synvisc-One® (Hylan G-F 20)

Synvisc and Synvisc-One are among the most established viscosupplements, distinguished by their unique hylan G-F 20 formulation.

Source & Composition: These products are avian-derived, sourced from rooster combs. Hylan G-F 20 is a chemically cross-linked hyaluronan derivative, which contributes to its high molecular weight and longer residence time in the joint.
Protocol: Synvisc® is a traditional three-injection series (one week apart), while Synvisc-One® provides the full treatment course in a single 6mL injection.
Duration: Both formulations provide pain relief for up to 6 months.
Best For: Patients without avian allergies. The choice between the 3-injection and single-injection protocol depends on patient preference, compliance concerns, and clinic workflow.

Durolane® (Non-Animal Stabilized Hyaluronic Acid – NASHA)

Durolane is another leading single-injection treatment, engineered for enhanced longevity and efficacy.

Source & Composition: It is made from highly purified, non-animal stabilized hyaluronic acid (NASHA), which is chemically cross-linked for a longer-lasting effect.
Protocol: A single intra-articular injection.
Duration: Substantial pain relief is typically reported for up to six months, with some patient data indicating benefits extending even longer.
Best For: Patients with osteoarthritis of the knee. Its application for other joints like the shoulder is considered off-label but is a common and medically accepted practice based on clinical evidence.

Hymovis® (HYADD®4 Technology)

Hymovis is a next-generation viscosupplement with a unique formulation designed for enhanced viscoelasticity and durability.

Source & Composition: It utilizes HYADD®4, a proprietary modified hyaluronic acid derived from bacterial fermentation (non-avian source), providing superior resistance to degradation.
Protocol: A convenient two-injection regimen, typically administered one week apart.
Duration: Provides significant pain reduction and improved joint function for up to 6 months (26 weeks).
Best For: Patients who appreciate a simplified injection schedule (fewer than 3-5 injections) and require a durable, non-avian derived product.

Administration Protocol & Best Practices

Regardless of the brand chosen, strict adherence to clinical best practices is paramount for ensuring patient safety and maximizing therapeutic outcomes.

Patient Selection: The ideal candidate has symptomatic knee or shoulder OA (typically Kellgren-Lawrence Grade II-III) and has failed to achieve adequate relief with conservative therapies. A thorough patient history must be taken to screen for contraindications, especially avian allergies for products like Synvisc®.
Aseptic Technique: Strict adherence to aseptic intra-articular injection technique is mandatory to minimize the risk of infection. The injection site must be thoroughly disinfected.
Patient Counseling: It is essential to manage patient expectations. Explain that pain relief is often not immediate and may take several weeks to become fully apparent. Discuss the expected duration of relief.
Post-Injection Care: Advise patients to avoid strenuous activities, heavy lifting, or prolonged weight-bearing for approximately 48 hours post-injection. Localized reactions like temporary pain or swelling can be managed with ice and simple analgesics.

By integrating these therapies into a comprehensive multimodal OA management plan that includes physical therapy and weight management, clinicians can significantly improve the quality of life for their patients.

Conclusion

Modern orthopedic injectables offer a diverse and effective range of non-surgical options for managing osteoarthritis pain. Single-injection therapies like Monovisc® and Durolane® provide maximum convenience, while multi-injection regimens and unique formulations like Hymovis® offer alternative, clinically-proven protocols. The choice of viscosupplement should be individualized, based on clinical evidence, patient allergy profiles, and treatment preferences.

By carefully selecting the appropriate product and adhering to best practices, clinicians can leverage these advanced therapies to provide sustained pain relief and restore mobility for their patients.

Shop Orthopedic Injectables for Your Practice

Frequently Asked Questions about Orthopedic Injectables

1. What is the main difference between single-injection and multi-injection HA treatments?

The primary difference is convenience and patient compliance. Single-injection treatments like Monovisc®, Synvisc-One®, and Durolane® complete the therapy in one visit. Multi-injection treatments like Synvisc® (3 injections) or Hymovis® (2 injections) require multiple clinic visits but are preferred by some clinicians for certain patients. Efficacy over 6 months is generally comparable between the approaches.

2. Why is the source of hyaluronic acid (avian vs. non-avian) important?

The source is critical for patient safety. Avian-derived products (like Synvisc®) are sourced from rooster combs and are contraindicated in patients with known allergies to eggs, feathers, or poultry. Non-avian products (like Monovisc®, Durolane®, Hymovis®) are produced via bacterial fermentation and are a safer alternative for these patients.

3. How long do the effects of a viscosupplement injection typically last?

Most modern viscosupplements, whether single or multi-injection, provide clinically significant pain relief and functional improvement for up to 6 months. Some patients may experience benefits for even longer periods.

4. What are the most common side effects of these injections?

The most common side effects are mild and temporary reactions at the injection site, including pain, swelling, stiffness, and bruising. These typically resolve on their own within a few days. Serious complications are rare.

5. Is the use of Durolane for shoulder osteoarthritis FDA-approved?

Durolane is specifically FDA-approved for osteoarthritis of the knee. Its use for the shoulder is considered an “off-label” application. This is a common and medically accepted practice where clinicians use a product for a condition based on strong clinical evidence and professional judgment, even if it’s not the primary approved indication.

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.