From the Guidelines
The recommended treatment protocol for Synvisc (hylan G-F 20) injections in the knee for osteoarthritis is not supported by recent high-quality evidence, and its use is conditionally recommended against by the 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee 1. Instead, the guideline strongly recommends against hyaluronic acid injections in hip OA and conditionally recommends against them in knee OA. The treatment of knee osteoarthritis typically involves a series of conservative measures, including:
- Weight loss, if overweight or obese
- Exercise, such as strengthening, low-impact aerobic exercise, and neuromuscular education
- Oral or topical nonsteroidal anti-inflammatory drugs (NSAIDs)
- Acetaminophen
- Intra-articular corticosteroid injections for moderate to severe pain
- Alternative therapies, such as physical therapy, manual therapy, and assistive devices.
The use of hyaluronic acid injections, such as Synvisc, is not recommended due to the lack of high-quality evidence supporting their effectiveness and the potential risks associated with their use 1. It is essential to note that the management of osteoarthritis should be individualized, and treatment decisions should be based on the patient's specific needs, risk factors, and preferences. In conclusion, while hyaluronic acid injections, such as Synvisc, may have been used in the past to treat knee osteoarthritis, the current evidence does not support their use, and alternative treatments should be considered.
From the Research
Treatment Protocol for Synvisc Injections in the Knee for Osteoarthritis
- The recommended treatment protocol for Synvisc (hylan G-F 20) injections in the knee for osteoarthritis involves a single-injection regimen, as supported by the LOBRAS study 2.
- This study found statistically significant improvements in WOMAC Pain, Stiffness, Function, and Total Score, as well as SF-36 PCS and WOMAC-derived HUI3 outcomes, at multiple time points up to 52 weeks after injection.
- The effectiveness of single-injection hylan G-F 20 is also complemented by previous observations in routine clinical care, with few patients experiencing treatment-related adverse events 2.
Comparison with Other Treatments
- A systematic review and network meta-analysis compared the efficacy and safety of corticosteroids, hyaluronic acid, and PRP, and combination therapy for knee osteoarthritis 3.
- The results showed that PRP and PRP + HA were the most successful in improving function and alleviating pain after 3,6, and 12 months of follow-up.
- Another study found that repeated co-injections of corticosteroids plus HA more effectively decreased pain and improved physical function and physical functional performance than injections of HA alone from 1 week through 6 months posttreatment 4.
Delay to Knee Arthroplasty
- A study investigated whether intra-articular injection of Synvisc is associated with a delay to knee arthroplasty in patients with knee osteoarthritis 5.
- The results showed that HA patients had significantly longer adjusted median time to KA by at least 7 months, and Synvisc patients had 1.7 months longer time to KA than non-Synvisc HA patients.
- Another study found that the use of intra-articular HA injections did not significantly reduce the risk of composite surgical interventions, including total knee arthroplasty, compared to corticosteroid users and HA/CS nonusers 6.