Comparing Monovisc vs Orthovisc for Osteoarthritis

Osteoarthritis is one of the most common forms of arthritis in the world, so it is no wonder that medical professionals constantly look for new solutions that can ease the symptoms of the condition. While some patients find relief in conservative therapies like physical therapy, weight management, and NSAIDs, others who do not benefit from such treatments usually turn to viscosupplementation. Some of the top choices here are Monovisc and Orthovisc, which stand out for their effectiveness, safety, and patient satisfaction. This article offers a detailed comparison of these two HA-based products to help healthcare professionals and patients make the right choice.

Overview of Monovisc and Orthovisc

Both Monovisc and Orthovisc are injectable viscosupplements designed to treat osteoarthritis of the knee. They are FDA-approved for use in patients who have not responded adequately to conservative treatment options. These treatments do not cure osteoarthritis, but they help relieve pain and improve joint mobility by supplementing the synovial fluid in the affected joint.

What sets both products apart from older generations of viscosupplements is the fact that their hyaluronic acid content is non-animal-derived. Manufactured through bacterial fermentation, they significantly reduce the risk of allergic reactions, especially in patients sensitive to avian proteins.

Both Monovisc and ORTHOVISC® contain high molecular weight hyaluronic acid that mimics the viscoelastic properties of healthy synovial fluid. By restoring lubrication and cushioning within the joint, they help reduce mechanical stress and inflammation, ultimately easing discomfort during movement. 

Treatment Protocols

The key difference between Monovisc and Orthovisc lies in their treatment regimens.

Monovisc is a single-injection treatment, containing 4 mL of HA (88 mg total). It provides patients with a convenient, one-time administration that delivers the entire therapeutic dose in just one visit. 

ORTHOVISC®, on the other hand, requires a three-injection protocol where 2 ml (30 mg HA) is administered weekly in the course of three weeks. Therefore, the total dose is also slightly higher at 90 mg. 

Pros and Cons of Single vs Multiple Injections

Monovisc appeals to patients who prefer fewer visits to their physician or are uncomfortable with needles. It is especially attractive for active individuals, older patients with transportation issues, or those with comorbidities that make frequent office visits challenging.

On the contrary, ORTHOVISC® allows clinicians to monitor the treatment over time so they can track the symptoms and reactions between the injections with more accuracy. Additionally, multiple injections might also allow for greater intra-articular distribution and sustained viscosity over time.

Efficacy and Patient Outcomes

Both Monovisc and Orthovisc have demonstrated significant efficacy in reducing pain and improving function in patients with knee osteoarthritis.

Monovisc generally shows a faster onset of action, with some patients experiencing pain relief within one to two weeks. The peak therapeutic effect is typically seen around 4–6 weeks post-injection, with benefits lasting up to 6 months in many cases.

ORTHOVISC® may require a slightly longer period to reach full effectiveness due to its way of dosing. Patients often experience noticeable relief by the time the second or third injection is administered. Just like with Monovisc, the results can last up to 6 months, depending on individual factors such as activity level, joint damage severity, and other conditions.

While the differences in efficacy are not huge, some studies suggest that patients receiving multiple injections (as with ORTHOVISC®) may experience slightly more consistent long-term results, especially those with moderate osteoarthritis.

Convenience and Compliance

Convenience is a very important factor in the overall patient experience. Therefore, Monovisc is ideal for patients who prefer simplified treatment plans. Besides the obvious benefits of getting only one injection, this convenient treatment schedule can also lower indirect costs like travel time or time off work. 

When it comes to ORTHOVISC®, we may say that it is more demanding in terms of scheduling, as it allows clinicians to monitor and tailor the treatment more precisely.

Patients who are hesitant about injections may prefer Monovisc, but those who are seeking potentially stronger or longer-lasting outcomes may be more willing to undergo a multi-injection protocol like ORTHOVISC®.

Safety and Side Effects

Both Monovisc and ORTHOVISC® are generally safe and well-tolerated by patients, with low occurrences of side effects. Also, since they are non-animal-derived, they carry a minimal risk of allergic response.

The most commonly reported Monovisc and Orthovisc side effects include:

• Temporary swelling, stiffness, or warmth at the injection site
  
• Mild pain or bruising near the injection area
  

Rare but possible complications may include:

• Pseudoseptic reactions, where patients develop acute inflammation within 72 hours post-injection, though this is extremely rare
  
• Infection, if aseptic technique is not strictly followed
  

There are no known systemic effects from either product, making them appropriate for elderly patients or those with complex medical histories.

Cost Considerations

Cost is a major factor when deciding between these two viscosupplements, especially for practices managing budgets or patients paying out of pocket.

Monovisc, as a single-injection product, generally costs more per syringe but may be less expensive overall due to fewer office visits and procedural fees.

ORTHOVISC®, although less expensive per syringe, involves three visits, potentially increasing total cost due to clinical time, staff resources, and patient travel.

Insurance coverage can vary. Some insurance plans prefer single-injection options like Monovisc for cost-effectiveness, while others may only reimburse multi-injection protocols like ORTHOVISC® based on clinical guidelines. Therefore, it is up to the patient to decide what works better with their own insurance plan. 

Clinicians should also be involved here. They should communicate with insurers or prior authorisation teams to ensure patients will not be faced with unexpected bills.

Which One to Choose?

There is no universal answer to which product is better. The choice between Monovisc and ORTHOVISC® depends on several clinical and logistical factors.

• For busy patients, those uncomfortable with multiple injections, or individuals seeking quick convenience, Monovisc is often preferred.
  
• For patients needing careful monitoring, those with moderate OA, or clinics favouring incremental treatment strategies, ORTHOVISC® may offer a more tailored approach.
  
• The choice may also be influenced by insurance policies, clinical protocols, and a physician’s experience with either product.
  

Whether you are choosing between these two or you are having a whole other selection in mind (e.g. Euflexxa vs Orthovisc), you should know that in the end, the best viscosupplement is the one that aligns with the patient’s lifestyle, symptom severity, and treatment goals, as well as the clinic’s standard of care.

Conclusion

When comparing Monovisc and ORTHOVISC® for the treatment of knee osteoarthritis, both offer proven relief through viscosupplementation and share a strong safety profile. The key differences lie in dosing protocols, convenience, and potential for tailored care. When it comes to the final decision, it should involve both the physician and the patient. Conveniently enough for medical professionals, they can order Orthovisc online from Best Buy Fillers, and Monovisc is also easily accessible on this webshop.

References: 

Win Min Oo, Hunter DJ. Intra-articular Therapies for Knee Osteoarthritis: Current Update. Current Treatment Options in Rheumatology. 2023;9(3):99-119.

Peck J, Slovek A, Miro P, et al. A Comprehensive Review of Viscosupplementation in Osteoarthritis of the Knee. Orthopedic Reviews. 2021;13(2).

Petterson SC, Plancher KD. Single intra-articular injection of lightly cross-linked hyaluronic acid reduces knee pain in symptomatic knee osteoarthritis: a multicenter, double-blind, randomized, placebo-controlled trial. Knee Surgery, Sports Traumatology, Arthroscopy. Published online August 29, 2018.