Osteoarthritis (OA) is a chronic, progressive condition that significantly impacts the quality of life for millions of individuals worldwide. Characterized by the gradual deterioration of cartilage, OA leads to constant joint pain, stiffness, and decreased mobility.

For those suffering from knee osteoarthritis, intra-articular injections have become the most important, non-surgical solution. These injections deliver medication directly into the joint, relieving pain and inflammation.

Among the most widely used and researched treatments in this category are Orthovisc and Synvisc, two hyaluronic acid (HA) injections that have gained attention for alleviating symptoms and improving joint function.

While both Orthovisc and Synvisc share the common goal of symptom relief, they differ in their molecular composition, source, and clinical application. We will explore the key distinctions in the Orthovisc vs Synvisc injection comparison, analyzing their formulations, efficacy, safety profiles, and patient suitability

Comprehending Hyaluronic Acid (HA) Therapy

Hyaluronic acid (HA) is a key component of synovial fluid. It reduces friction between cartilage surfaces, acting as both a lubricant and a shock absorber in joints.

People suffering from osteoarthritis have lower quantity and quality of HA in the synovial fluid.

Hyaluronic acid injections, including Orthovisc and Synvisc, are designed to replenish the diminished hyaluronic acid in the joints. Once HA is placed directly into the joints, it will help reduce pain, improve joint flexibility, and enhance overall mobility.

This therapy can slow the progression of osteoarthritis, along with symptomatic relief.

Orthovisc: An In-Depth Analysis

Orthovisc is a non-animal-sourced hyaluronic acid (HA) product developed through bacterial fermentation. Such a production method provides a high purity level and reduces the risk of allergic reactions associated with animal-derived products.

This product is notable for its high molecular weight, ranging from 1.0 to 2.9 million Daltons. This high molecular weight makes it more effective in mimicking the natural lubrication and cushioning provided by synovial fluid in healthy joints.

Also, Orthovisc injection has a high concentration of HA at 15 mg/ml, which contributes to significant symptomatic relief in osteoarthritic joints. The combination of its molecular weight and concentration makes Orthovisc such a powerful option.

Treatment Protocol

It is given as a series of three to four injections spaced one week apart. This regimen should have a cumulative effect, with each injection building upon the previous one. Its high molecular weight enables it to remain in the joint space for an extended period.

Synvisc: A Comprehensive Overview

Synvisc is a hyaluronic acid (HA) product derived from a natural source — specifically, the combs of roosters. It consists of two types of Hylan, A and B, chemically cross-linked to form a gel-like substance.

This cross-linking process significantly enhances Synvisc’s viscoelastic properties. Thus, it has a molecular weight of approximately 6 million Daltons, considerably higher than that of Orthovisc.

The increased molecular weight and gel-like consistency are key factors that explain why some practitioners and patients choose Synvisc over Orthovisc.

Synvisc is available in two formulations: the standard Synvisc, which requires a series of three injections, and Synvisc-One, a single-injection option.

Treatment Protocol

The standard Synvisc regimen involves three injections, administered one week apart. This multi-dose approach should lead to a gradual buildup of Synvisc in the joint. On the other hand, Synvisc-One offers a single-injection alternative, which is a more convenient option than adhering to a multi-injection schedule.

Orthovisc vs Synvisc Injection Key Differences

Orthovisc and Synvisc share many benefits, including the fact that both have been extensively studied in clinical settings, with numerous studies supporting their efficacy in managing osteoarthritis symptoms. This is very important and separates them from many other products not yet backed up by respectable studies.

Some of the main differences are the following:

Molecular Composition and Viscosity

A fundamental distinction between Orthovisc and Synvisc is molecular composition and viscosity, which directly affect their therapeutic properties, and we have already briefly explained them.

Orthovisc is derived from bacterial fermentation, resulting in a non-animal-sourced hyaluronic acid (HA) with a high molecular weight ranging from 1.0 to 2.9 million Daltons.

In contrast, Synvisc injection is composed of chemically cross-linked Hylan A and B polymers, giving a higher molecular weight of approximately 6 million Daltons. So, Synvisc is designed to resemble the natural synovial fluid more closely.

Duration of Effectiveness

Both Orthovisc and Synvisc should provide long-lasting relief from the symptoms of osteoarthritis, with their effects lasting up to six months or even a bit more.

Synvisc’s higher molecular weight may offer slightly longer-lasting effects in certain patients, especially when administered as Synvisc-One.

Patient Suitability and Preferences

Patient suitability for Orthovisc versus Synvisc often hinges on individual factors such as the severity of osteoarthritis, previous treatment outcomes, and potential allergies.

For instance, Orthovisc, being non-animal-based, is an ideal option for patients with known allergies. Nevertheless, Synvisc-One’s convenience of a single dose is perfect for patients seeking minimal disruption to their routine.

Cost and Insurance Coverage

Cost always plays a huge role in decision-making.

Orthovisc is generally a bit cheaper because of its simpler manufacturing process. Yet, the cost-effectiveness of Synvisc, particularly Synvisc-One, should not be overlooked, as its single-injection regimen can reduce the overall number of office visits and associated costs.

The financial aspect of these treatments is further complicated by varying insurance coverage policies. So, you need advice from professionals on which one to choose.

Conclusion

As the global population ages and the prevalence of obesity rises, the incidence of OA continues to increase, making effective treatment options more critical than ever.

Orthovisc and Synvisc are two of the most reliable and widely-used hyaluronic acid (HA) injections for managing osteoarthritis, particularly in the knee joint.

Each product offers distinct advantages. The choice between Orthovisc and Synvisc is not merely a matter of preference. It should be guided by a thorough understanding of their differences, especially molecular composition, origin, viscosity, and duration of action.

Orthovisc’s non-animal origin makes it more suitable for patients with allergies. At the same time, Synvisc’s higher molecular weight and option for a single injection (Synvisc-One) may appeal to those looking for long-term relief with fewer office visits.

Frequently Asked Questions (FAQ)

Are there any differences in how Orthovisc and Synvisc are stored or handled?

Both Orthovisc and Synvisc require refrigeration and protection from light. However, Synvisc, due to its avian origin, may have stricter handling guidelines to maintain its efficacy.

How do lifestyle factors influence the effectiveness of Orthovisc vs Synvisc injection?

Lifestyle factors, such as weight, activity level, and overall joint health, can influence the effectiveness of both Orthovisc and Synvisc. Maintaining a healthy weight and staying active can enhance the benefits.

Can Orthovisc and Synvisc be used in joints other than the knee?

Yes, both Orthovisc and Synvisc have been used in other joints, often the hip and shoulder, although the knee is the most common application.

How do Orthovisc and Synvisc affect the progression of osteoarthritis?

Neither Orthovisc nor Synvisc halts the progression of osteoarthritis, but they help manage symptoms. Their use can delay the need for more invasive treatments.

References

McElheny K, Toresdahl B, Ling D, Mages K, Asif I. Comparative Effectiveness of Alternative Dosing Regimens of Hyaluronic Acid Injections for Knee Osteoarthritis: A Systematic Review. Sports Health. 2019 Sep/Oct;11(5):461-466. doi: 10.1177/1941738119861545. Epub 2019 Jul 24. PMID: 31340715; PMCID: PMC6745818.

Yoshioka K, Katayama M, Nishiyama T, Harada K, Takeshita S, Kawamata Y. Biocompatibility study of different hyaluronan products for intra-articular treatment of knee osteoarthritis. BMC Musculoskelet Disord. 2019 Sep 12;20(1):424. doi: 10.1186/s12891-019-2815-6. PMID: 31511072; PMCID: PMC6739973.