Viscosupplementation (hyaluronan injections)

Drug Name
Viscosupplementation (hyaluronan injections)

Brand Name(s)
NeoVisc®, SynVisc®, SynVisc One®, Durolane®, Euflexxa®

Drug Class

These injections have been shown to have modest benefits in mild to moderate osteoarthritis (OA) of the hip and knee.

  • What types of arthritis is viscosupplementation used for?

    These injections may provide short term (up to 26 weeks) benefits in mild to moderate osteoarthritis (OA) of the knee when first line agents have failed or are not tolerated.  Evidence to support use of viscosupplementation for osteoarthritis of the hip is currently lacking however they may be an option if relief is not obtained from first line therapies.

    There is no evidence to support the use of one viscosupplementation product over the other in terms of safety and effectiveness.  

    The cost of viscosupplementation injections ($200 - $350/treatment course) can limit their use. 

    Viscosupplementation is not used in the management of inflammatory arthritis.

  • How is viscosupplementation administered?

    Viscosupplementation agents are injected directly into a joint.

  • What is the typical dose and when do I take it?

    One injection into the involved joint. May be given once only or weekly for three to five weeks depending on affected joint and product used.

  • How long will it take to work?

    The onset of relief is slower (several weeks) than with steroid injections, but the effect may last longer. This may vary from person to person.

  • When should I not use viscosupplementation and call my doctor?

    Do not use viscosupplementation products if you have had an allergy to hyaluronan preparations.

    Do not use viscosupplementation products if you have a joint infection or an infection of the skin near the injection site.

  • What are the side effects of viscosupplementation?

    The most common adverse events reported have been pain, swelling and/or inflammation in the injected knee.

    There have been rare reports of viscosupplementation products causing a drop in blood counts and fever. People have also rarely reported pseudogout (sudden, painful swelling in one or more of your joints).

  • What helps to reduce side effects?

    If possible, rest the joint for 48 hours after the injection.

    If you experience discomfort in the joint after the injection you may treat the discomfort by applying a cold pack or by using medications, such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs). Please check with your doctor.

  • Do I need any monitoring if I have been given a viscosupplementation injection?

    Routine blood tests are not required with viscosupplementation products.

    Your health-care provider may meet with you regularly to ensure that the viscosupplementation product is adequately controlling your OA pain and not causing adverse effects.

This information was last updated November 2017, with expert advice from:

Jason Kielly, B.Sc. (pharm.), Pharm.D.
Assistant Professor, School of Pharmacy, Memorial University of Newfoundland
Clinical Pharmacist, Rheumatic Health Program, Eastern Health

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