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Orthovisc vs. Synvisc: Which Viscosupplement to Choose?
Feb 3, 2023
Understanding of Viscosupplements
Intra-articular injections of hyaluronic acid preparations are one of the most effective methods of joint osteoarthritis treatment. Since 2003, this method has been on the list of measures recommended by the World Health Organization for patients with mild to moderate symptoms of osteoarthritis (stages 2 and 3 by Kellgren).
Most often, intraarticular therapy with hyaluronic acid preparations is used in conjunction with other conservative treatment methods: pills, ointments, regular injections, etc. It significantly reduces dependence on analgesics and anti-inflammatory pills, has a long-term therapeutic effect, slows the rate of progression of osteoarthritis, and allows you to postpone joint replacement surgery for a long time.
Knee Osteoarthritis and Hyaluronic Acid
Hyaluronic acid is part of the synovial fluid of a healthy knee joint and is a natural structural component of articular cartilage. With osteoarthritis in the joint’s synovial fluid, there is a decrease in the concentration of hyaluronic acid, which leads to increased friction in the joint and degenerative changes in the cartilage. Intra-articular injection of hyaluronic acid products has a positive effect on the metabolic processes in the tissues of the joint and cartilage: sodium hyaluronate forms a protective film on the damaged cartilage, protecting it from further destruction and improving the slip of the contacting cartilage surfaces. In addition, preparations of hyaluronic acid penetrate deep into the cartilage, improving its elasticity and flexibility. Thanks to hyaluronic acid, the cartilage, which has “dried up” and thinned in arthritis, regains its cushioning properties. As a result, pain and stiffness in the joints are reduced, and function and range of motion are restored.
What can I expect from intra-articular hyaluronic acid injections?
- Reduced pain and improved joint mobility;
- Reduced demand for painkillers and anti-inflammatory pills;
- The year-long therapeutic effect after the complete course of treatment;
- Stimulation of natural hyaluronic acid synthesis and restoring the elasticity of articular cartilage;
- Deceleration of osteoarthritis progression and the possibility of avoiding radical surgery for artificial joint replacement;
- Excellent tolerability and lack of severe side effects.
Orthovisc vs. Synvisc Comparison
What is Orthovisc?
Orthovisc injections are a hyaluronan solution in the form of a single-use syringe. Orthovisc hyaluronan solution is clear, non-pyrogenic, viscoelastic, and sterile. It is the ultra-pure physiological saline solution and high molecular weight hyaluronic acid.
What is Synvisc?
Synvisc l/Synvisc One is a sterile, apyrogenic, viscoelastic fluid containing hylans. Hylans are derivatives of hyaluronan (sodium salt of hyaluronic acid) and consist of repeating disaccharide links of N-acetylglucosamine and sodium glucuronate. Synvisc is a biological analog of hyaluronan. Synvisc’s mechanical (viscoelastic) properties are higher than those of synovial fluid and hyaluronan solution in comparable concentrations.
Orthovisc vs. Synvisc: Similarities
Orthovisc and Syncisc, knee osteoarthritis medications, have both similarities and differences. Let’s look at the similarities first.
Active ingredient. The action of each medication is based on a hyaluronan (hyaluronic acid) solution. These products are designed to treat osteoarthritis. Since hyaluronic acid is a component of natural synovial fluid and serves as a lubricant for the joints, the injection of Orthovisc and Synvisc can reduce the symptoms of osteoarthritis, increase joint mobility, reduce pain and stiffness, thus improving the quality of life of patients.
The technique of administering Synvisc and Orthovisc is the same: Medication is injected intra-articularly with a syringe into the synovial space. The procedure is delicate and should only be performed by an experienced professional.
Both products have been clinically tested, have proven safe, and have gained clients’ trust, giving relief to many people suffering from osteoarthritis. However, like any medication, especially one that requires invasive application, they also have restrictions.
- Venous or lymphatic stasis on the affected joint;
- An infected joint;
- Signs of joint inflammation;
- Skin lesions and symptoms of skin infection close to the injection site.
In addition, there is no information on how they affect pregnant and breastfeeding women, so they should refrain from using Orthovisc and Synvisc.
Possible Side Effects
Side effects for Synvisc and Orthovisc are similar.
Adverse effects at the joint after injection: short-term joint pain (arthralgia) and short-term joint edema or joint effusion.
Reactions at the injection site: pain/sensitivity, bruising, swelling, bleeding, itching, skin redness, rash, local fever;
Systemic reactions: rash, urticaria, itching, fever, nausea, headache, dizziness, chills, muscle cramps, paraesthesia, peripheral edema, difficulty breathing, weakness, skin redness, and facial edema; incidence unknown (cannot be calculated from available data)
Where to buy?
You can order both products from regional medical distributors or wholesale distributors or buy Orthovisc online at Maylips.com. The latter option will be more convenient and probably cheaper.
Orthovisc Vs. Synvisc: Distinctions
Orthovisc and Synvisc, osteoarthritis medications, have many similarities because they are designed for the same purpose. But they have several differences in composition, the number of injections needed, and so on. Let’s discuss the differences between the medications in more detail.
The Origin of an Active Ingredient
Orthovisc is a viscous, sterile mixture whose active ingredient is hyaluronic acid (hyaluronan). This substance is found in joint tissues as well as in synovial fluid and serves as a lubricant and shock absorber. Orthovisc uses highly purified sodium hyaluronate, which is extracted from rooster combs.
Synvisc is an elastoviscous fluid containing hylan polymers produced from chicken combs. Hylans are derivatives of hyaluronan, a natural complex sugar of the glycosaminoglycan family. Synvisc contains Hylan A (average molecular weight 6,000,000) and Hylan B hydrated gel in a buffered physiological sodium chloride solution, pH 7.2.
Formulation of orthopedic injectables
According to Nicholls, M., Manjoo, A., Shaw, P, the molecular weights of Orthovisc and Synvisc products, zero shear rate viscosity, shear thinning ratio, and crossover frequency differ. Moreover, differences were observed in all the studied parameters. Orthovisc has a linear chain structure, while Synvisc is cross-linked in structure.
The Number of Injections
Orthovisc prescribing information says that treatment involves one weekly injection for three weeks.
The injection regimen depends on the joint to be injected. The recommended treatment regimen is three injections of 2 ml into the knee joint. The interval between injections is one week. But it is also possible to use the same product in a different dosage, Synvisc One. The treatment regimen is one injection into the knee joint.
Prices for Orthovisc injection vs. Synvisc in clinics can vary widely, although Synvisc is usually slightly more expensive. If you order online, the cost of Orthovisc (one dose) will be $39.00 (or cheaper if you order in bulk). And if you buy Synvisc online, the price is $159.00 for a pack of 3 2 ml syringes (standard course of treatment).
Synvisc One (one 6 ml syringe) costs the same, $159.00, but is used for a single treatment.
Efficacy of Orthovisc And Synvisc Against Osteoarthritis
Synovial fluid in knee joints helps soften the friction of articular cartilage surfaces by acting as a viscous lubricant during slow joint movements and an elastic shock absorber during rapid movements. Hyaluronan is the main component of synovial fluid, and patients with osteoarthritis have an insufficient concentration of hyaluronic acid. Sodium Hyaluronate injections help restore the normal properties of the synovial fluid, thereby reducing to some extent the pain and discomfort associated with osteoarthritis.
The therapeutic effects of intra-articular injection of Hyaluronate can be divided into short-term and long-term. The injection instantly provides quality intra-articular lubrication by improving the visco-elastic properties of the synovial fluid. Also, sodium hyaluronate has a local anti-inflammatory effect (due to increased synthesis of prostaglandins and suppression of production of inflammatory mediators), analgesic (due to reduced synthesis of bradykinin and substance P), and chondroprotective effect over the long term. The injections also increase the production of endogenous Hyaluronate and prevent cartilage destruction, contributing to its regeneration.
Treatment courses with Hyaluronate can significantly improve the functionality of the joint, reduce pain, and in more severe cases: delay the need for surgery on the knee joint. It is also the preferred treatment option if the patient cannot control osteoarthritis pain with nonsteroidal anti-inflammatory pills or tolerate them because of side effects (stomach bleeding and kidney problems).
Orthovisc, Synvisc, and other HA medications for osteoarthritis treatment are for professional use only.
Which knee injection lasts longer?
Synvisc was effective for up to 26 weeks in patients who responded to treatment, although shorter and longer periods have been observed. However, data from prospective clinical studies of patients with knee osteoarthritis have demonstrated treatment efficacy of up to 52 weeks after a single course of 3 injections.
Treatment with the Orthovisc line can provide four to six months of knee pain relief.
Thus, it is impossible to say undoubtedly that one of the treatments lasts longer.
What is the newest knee injection?
Orthovisc was approved by the FDA on February 4, 2004, for treating the pain associated with knee osteoarthritis.
Synvisc, on the other hand, was approved by the FDA on August 8, 1997. Therefore, Orthovisc can be considered a newer medication.
How long can you use Orthovisc?
If Orthovisc treatment is effective for you, you may repeat it in 6 months. However, consult your physician first.
What is the success rate of Synvisc?
The FDA has confirmed Synvisc’s efficacy, but you may look up the clinical trial results for more details.
You can also consider the reviews. For example, on drugs.com, Synvisc has an average rating of 6.3 out of 10, and 61% of patients reported a positive effect.
Even after a detailed review of both products, it’s hard to say which is better. Both are FDA-approved, clinically tested, used to treat the same problem, have similar (though not identical) formulations, and are administered similarly.
A decision on which medication to use may be based on factors such as the cost of Synvisc and Orthovisc, the number of sessions (Synvisc One offers triple-dose injection in one session), and your doctor’s recommendations.
- ORTHOVISC® High Molecular Weight Hyaluronan
- Synvisc Hylan GF 20 – Accessdata.fda.gov
- Nicholls, M., Manjoo, A., Shaw, P. et al. A Comparison Between Rheological Properties of Intra-articular Hyaluronic Acid Preparations and Reported Human Synovial Fluid. Adv Ther 35, 523–530 (2018).