From the Guidelines
Synvisc injection is not recommended for routine use in the treatment of symptomatic osteoarthritis of the knee. This recommendation is based on the most recent and highest quality study, which found that the evidence of lack of benefit is of higher quality with respect to hyaluronic acid injection in the knee 1. The American Academy of Orthopaedic Surgeons clinical practice guideline summary states that hyaluronic acid intra-articular injection(s) is not recommended for routine use in the treatment of symptomatic osteoarthritis of the knee, with a moderate strength of recommendation 1.
The 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee also conditionally recommends against the use of intraarticular hyaluronic acid injections in patients with knee and/or first CMC joint OA, citing limited evidence of benefit and potential harm 1. Similarly, another study found that the benefit of hyaluronic acid injections was restricted to studies with higher risk of bias, and that the effect size approaches zero when limited to trials with low risk of bias 1.
Key points to consider when evaluating the use of Synvisc injection include:
- The lack of strong evidence supporting its effectiveness in treating knee osteoarthritis
- The potential for harm or adverse effects associated with the injection
- The importance of considering alternative treatment options, such as physical therapy and appropriate exercise, as part of a comprehensive treatment plan
- The need for shared decision-making between the patient and healthcare provider, taking into account individual patient preferences and values 1.
In clinical practice, the decision to use Synvisc injection should be made on a case-by-case basis, considering the individual patient's circumstances and the potential benefits and risks of the treatment 1.
From the Research
Synvisc Injection Overview
- Synvisc injection is a type of viscosupplementation used to treat osteoarthritis (OA) of the knee 2.
- It is made from hyaluronan, a natural substance found in the body that helps to lubricate joints and reduce inflammation.
Efficacy of Synvisc Injection
- Studies have shown that Synvisc injection can be effective in reducing pain and improving function in patients with knee OA 2, 3.
- A study published in 2003 found that 82.1% of patients who received Synvisc injections experienced substantial improvement or subsidence of symptoms 2.
- Another study published in 2017 compared the efficacy of Synvisc-One with a novel hyaluronan (HYA-JOINT Plus) and found that both treatments were safe and effective, but HYA-JOINT Plus was superior in reducing pain scores 3.
Comparison with Other Treatments
- A systematic review and network meta-analysis published in 2023 compared the efficacy and safety of various injectable treatments for knee OA, including Synvisc, and found that platelet-rich plasma (PRP) and PRP plus hyaluronic acid (HA) were the most effective in improving function and alleviating pain 4.
- A study published in 2019 reviewed non-operative treatment options for knee OA and found that intra-articular injections, including Synvisc, can be effective in reducing pain and improving function, but the evidence is mixed and more research is needed 5.
- A randomized controlled trial published in 2022 compared the effects of repeated co-injections of corticosteroids plus HA with HA injections alone and found that the combination treatment was more effective in reducing pain and improving physical function 6.
Safety and Adverse Effects
- Synvisc injection is generally considered safe, with few adverse effects reported in clinical trials 2, 3.
- A study published in 2023 found that PRP, HA, and combination therapy did not result in an increase in treatment-related adverse events compared to placebo 4.
- Another study published in 2019 found that intra-articular injections, including Synvisc, can have adverse effects, but the risk is generally low 5.