Orthovisc is a high-molecular-weight hyaluronic acid viscosupplement used for the symptomatic treatment of knee osteoarthritis pain. Manufactured by Anika Therapeutics — the same company behind Monovisc — Orthovisc is a three- to four-injection regimen designed to restore the viscoelastic properties of synovial fluid, reduce joint pain, and improve function in patients with mild-to-moderate OA. This guide provides practitioners with everything they need to know about Orthovisc: its formulation, clinical evidence, injection technique, dosing schedule, side effects, and how it compares to other viscosupplementation products.

What Is Orthovisc?

Orthovisc is a sterile, non-pyrogenic, viscoelastic solution of ultra-pure, non-animal-sourced sodium hyaluronate derived through bacterial fermentation, which eliminates the allergy risk associated with avian-derived viscosupplements such as Synvisc or Hyalgan.

Key product specifications:

  • HA concentration: 15 mg/ml
  • Volume per injection: 2 ml (30 mg per injection)
  • Injections per course: 3–4 weekly injections
  • Molecular weight: 1–2.9 million Daltons (high molecular weight)
  • Origin: Non-animal, bacterial fermentation derived
  • Regulatory status: FDA-cleared (US), CE-marked (Europe)

Orthovisc’s high molecular weight HA closely mimics the natural HA found in healthy synovial fluid. Its non-animal origin is an important clinical consideration for patients with bird or egg allergies.

Licensed practitioners can order Orthovisc at wholesale prices through Bioresus, alongside the full range of orthopaedic injectables.

Indications for Orthovisc Injection

  • Adults with Kellgren-Lawrence Grade I–III knee osteoarthritis
  • Patients with inadequate pain control on NSAIDs, paracetamol, or physical therapy
  • Patients seeking a non-opioid, non-surgical pain management option
  • Active patients or those with occupational demands who need to maintain function
  • Patients who wish to delay or avoid total knee replacement surgery
  • Patients with avian or egg allergy who cannot receive animal-sourced HA products

Contraindications

  • Known hypersensitivity to hyaluronic acid or any component of the formulation
  • Active infection or skin disease at or around the injection site
  • Active knee joint infection or intra-articular infection
  • Venous or lymphatic stasis in the affected limb
  • Pregnancy or breastfeeding (limited safety data available)

Exercise caution in patients on anticoagulant therapy. A minimum washout period of 4–6 weeks between intra-articular corticosteroid and HA injections is generally recommended.

Orthovisc Dosage and Treatment Schedule

Standard Protocol

  • 3 weekly intra-articular injections of 2 ml each into the affected knee
  • Some clinical protocols extend to 4 injections for patients with more advanced OA
  • Injections administered at weekly intervals (7-day spacing recommended)
  • Re-treatment may be considered 6 months after the initial course, based on clinical assessment

The multi-injection protocol of Orthovisc differs from single-injection options such as Monovisc or Durolane. For practices where patient compliance with multiple visits is a concern, a single-injection alternative may be more appropriate. However, the staged approach allows clinical reassessment between appointments and enables mid-course adjustment.

Re-Treatment Considerations

Document baseline and follow-up pain scores (VAS/NRS) and functional status (WOMAC or KOOS) before each treatment course and at follow-up to make evidence-based re-treatment decisions.

Orthovisc Injection Technique

Equipment Required

  • Orthovisc 2 ml prefilled syringe
  • 21–23 gauge needle (not supplied)
  • Sterile gloves and draping
  • Antiseptic skin preparation solution (chlorhexidine or povidone-iodine)
  • Optional: local anaesthetic (lidocaine 1%) — Orthovisc does not contain integrated lidocaine

Injection Approaches

Superolateral approach (most common):

  • Patient supine with knee fully extended
  • Insert needle superior and lateral to the patella, directing medially and slightly inferiorly
  • Aspirate any significant effusion before injecting Orthovisc; inject 2 ml slowly with minimal resistance

Anteromedial or anterolateral approach (knee flexed at 90°):

  • Patient seated with knee at 90° flexion
  • Insert needle adjacent to the patellar tendon, medially or laterally
  • Useful for patients who cannot fully extend the knee

Ultrasound guidance is strongly recommended for all viscosupplementation injections. Imaging-guided injections consistently demonstrate higher intra-articular placement accuracy than landmark-guided techniques, particularly in obese patients or those with anatomical variation.

Post-Injection Instructions for Patients

  • Avoid strenuous activity, prolonged standing, and heavy lifting for 48 hours post-injection
  • Ice application to the knee for 15–20 minutes may help reduce discomfort and swelling
  • Mild swelling, warmth, or stiffness for 24–72 hours is expected and typically resolves without intervention
  • Pain relief from viscosupplementation typically takes 4–8 weeks to onset
  • Ensure patients understand they need to return for all injections to complete the course

Expected Clinical Outcomes

  • Significant reductions in pain VAS scores compared to saline control at 12 and 26 weeks
  • Clinically meaningful improvements in WOMAC pain, stiffness, and physical function subscales
  • Pain relief sustained for up to 6 months in responding patients
  • Responder rates of approximately 60–70% in patients with mild-to-moderate OA

As with all viscosupplementation products, outcomes are best in patients with Kellgren-Lawrence Grade II–III OA. Grade IV (bone-on-bone) OA patients are unlikely to achieve meaningful benefit.

Orthovisc Side Effects and Safety Profile

Common (Local, Transient)

  • Injection site pain — most frequently reported, typically mild and short-lived
  • Swelling or joint effusion — usually resolves within 48–72 hours
  • Warmth and redness around the knee
  • Temporary joint stiffness post-injection

Serious (Rare)

  • Septic arthritis — minimised with strict aseptic technique; urgent evaluation required if fever or rapidly worsening symptoms develop
  • Acute inflammatory (pseudoseptic) reaction — sudden pain and swelling within 24–72 hours; usually self-limiting
  • Hypersensitivity reactions — rare with non-animal sourced HA

Instruct patients to contact the clinic immediately if post-injection pain worsens after 72 hours, or if they develop fever, significant joint swelling, or systemic symptoms.

Orthovisc vs Other Viscosupplements

  • Orthovisc vs Monovisc: Monovisc is Orthovisc’s single-injection equivalent — both from Anika Therapeutics, both non-animal sourced. Monovisc offers greater scheduling convenience; Orthovisc suits practices preferring a staged multi-visit protocol.
  • Orthovisc vs Durolane: Durolane is a single-injection product (NASHA technology, 60 mg/3 ml). Orthovisc’s multi-visit protocol allows interim reassessment; Durolane is more convenient for patients.
  • Orthovisc vs Synvisc: Both are multi-injection protocols. Synvisc uses avian-derived HA, carrying a higher allergy risk. Orthovisc’s bacterial fermentation origin is preferable for patients with bird or egg allergy.
  • Orthovisc vs Euflexxa: Both are non-animal sourced, 3-injection regimens. Orthovisc uses higher molecular weight HA.
  • Orthovisc vs Supartz FX: Supartz FX is a 5-injection regimen derived from avian sources. Orthovisc’s shorter 3-injection protocol and non-animal origin give it a clinical advantage in most practice settings.

Patient Selection and Counselling

Ideal candidates:

  • Kellgren-Lawrence Grade II–III knee OA
  • BMI under 35 (higher BMI associated with reduced response)
  • No bird or egg allergy — but if present, Orthovisc’s non-animal origin makes it the preferred choice over avian-sourced alternatives
  • Patients or practices preferring a staged treatment approach

Key counselling points:

  • Orthovisc provides symptomatic relief, not disease modification
  • Three clinic visits over three weeks are required to complete the initial course — patient commitment is important
  • Onset of meaningful pain relief typically takes 4–8 weeks from the final injection
  • Duration of effect is typically 6 months; re-treatment courses can be repeated
  • Non-response is possible — approximately 30–40% of patients do not achieve meaningful relief

Ordering Orthovisc Wholesale

Licensed practitioners can order Orthovisc at wholesale prices from Bioresus. Browse the full orthopaedic injectable range including Orthovisc, Monovisc, Durolane, and Supartz FX. All products are sourced from authorised distributors. Contact the Bioresus team for volume pricing and account setup.

Conclusion

Orthovisc is a clinically well-supported, high-molecular-weight viscosupplement with a strong safety profile and a non-animal origin suitable for a wide patient population — including those with avian allergies. Its three-injection protocol offers practitioners the opportunity to clinically reassess between visits.For practices already offering Durolane or Monovisc, adding Orthovisc broadens the viscosupplementation options available and allows better tailoring of treatment to individual patient preferences and clinical needs.