Viscosupplementation – Injections for Relief for Painful Osteoarthritis in the Knees

A man have problem of his knee wearing knee pads.

According to the Arthritis Foundation it is estimated that as many as 54.4 million adult Americans have doctor-diagnosed arthritis. In fact, according to a 2017 study by the foundation, the number may be higher, with as many as 91 million Americans suffering from this painful and sometimes crippling condition. Of the more than 100 different types of arthritis and related conditions, osteoarthritis is the most common type, affecting nearly 21 million Americans age 25 and older.

Osteoarthritis is the gradual wearing away of the cartilage in the knee joint. It is known as a degenerative form of arthritis, and while there is no cure for osteoarthritis, but there are treatments available.

Doctors will usually suggest lifestyle changes such as weight loss, physical therapy and changes in activity level to help ease the discomfort of osteoarthritis in early stages. Certain pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDS) or acetaminophen can also be recommended by doctors.

The next phase of treatment usually involves viscosupplementation with some form of hyaluronic acid.

Let’s start with the facts: Also known as hyaluronan injection or hyaluronic acid (HA) injection, viscosupplementation is a procedure during which a doctor will inject a lubricating fluid or gel into a joint, usually as a treatment for osteoarthritis in the knee, to help the joint move easier and relieve pain and inflammation. In this article we will discuss three medications used to treat osteoarthritis in the knee and what they are made of.

Hyaluronic acid may sound ominous but it is actually a natural substance in the fluid surrounding your joints. This fluid is the synovial fluid. The hyaluronic acid is like a gel that helps the bones move around each other and helps protect them from impacting against each other. When you suffer from osteoarthritis you have less hyaluronic acid than you should, and viscosupplementation helps by replacing that lost hyaluronic acid and therefore reduces pain and helps protect your bones and improve movement. The procedure usually involves several shots over several weeks. If effective, the injections may be repeated after 6months or so, depending on your results and your doctor’s orders.

There are different types of injectable hyaluronic acid viscosupplements used by doctors as treatment for osteoarthritis in the knee.


Orthovisc ® is made of highly purified sodium hyaluronate (aka hyaluronan) in physiologic saline. It comes in a prefilled syringe containing a 2 mL dose. Your doctor will inject Orthovisc® into the affected joint once a week, sometimes up to three weeks. The dose is determined by your doctor according to your individual medical condition. Side effects may include headache, swelling, pain, redness or warmth and bruising at the site of the injection. If any of these side effects get worse or persist, inform your doctor immediately. Always consult your prescription medication information sheet for all interactions, side effects and instructions.

Further information on Orthovisc ® can be found at the following link: Learn More

Synvisc ® (hylan G-F 20)

Synvisc® is an also an injectable fluid, containing hylan A fluid, hylan B gel, and salt water. Both Hylan A and hylan B are derived from hyaluronan, made from chicken combs. It was approved by the FDA in 1997, and is considered a treatment, not a drug. Synvisc® injections are usually given as a series of injections, once a week for three weeks, and is only used for treatment of osteoarthritic knees. Synvisc® comes in a 2.25 mL glass syringe containing one 2 mL dose of hylan G-F 20. For best results most doctors will remove osteoarthritic synovial fluid from the knee before the first injection is given.

Further information on Synvisc-One® can be found at the following link: Learn More

Synvisc-One ® (hylan G-F 20)

Synvisc-One® is another injectable gel that can provide up to six months of osteoarthritis knee pain relief with only one injection, compared to Synvisc® which is given in a series of 3 injections. Like Synvisc®, Synvisc-One® is made from hyaluronan. Each 10 Ml dose of Synvis-One® comes in a glass syringe and combines three 2-mL doses of a complete Synvisc® treatment. The single 10-mL syringe contains: sodium chloride (51mg), hylan A and hylan B (48mg), disodium hydrogen phosphate (0.96mg), sodium dihydrogen phosphate monohydrate (0.24mg), and water for injection (q.s to 6.0 mL) Always consult your prescription medication information sheet for all interactions, side effects and instructions.

Further information on Synvisc-One® can be found at the following link: Learn More


Durolane® is also a single-injection hyaluronic acid treatment, and has been licensed for the symptomatic treatment associated with mild to moderate osteoarthritis in the ankle, fingers, toes, as well as hips and knees. The hyaluronic acid in Durolane® is a stabilized form known as NASHA®. It is a purified product created without using any animal-sourced materials. Some of the benefits reported by Bioventus, the maker of Durolane® include ease of administering the injection, the prevention or delay of hip or knee replacement surgery, the ability to directly treat the affected joint, and the treatment is repeatable as required by your doctor. Durolane® is available in two doses – Durolane® (3 mL) and Durolane® SJ (1 mL). Be sure to consult your prescription medication information sheet for all interactions, side effects and instructions.

Further information on Durolane® can be found at the following link: Learn More

If you have questions about your prescription or non-prescription medication, please contact the team at Canada Online Health by calling toll free 1-800-399-DRUG (3784) or visit their website at One of the friendly and discreet pharmacy representatives will be happy to answer your questions. 

This article contains medical information provided to help you better understand this particular medical condition or process, and may contain information about medication often used as part of a treatment plan prescribed by a doctor.  It is not intended to be used as either a diagnosis or recommendation for treatment of your particular medical situation.  If you are unwell, concerned about your physical or mental state, or are experiencing symptoms you should speak with your doctor or primary health care provider. If you are in medical distress please contact emergency services (such as 911).