Orthovisc Side Effects: What Providers Should Monitor & Patients Should Know

Osteoarthritis (OA) of the knee is a chronic degenerative condition affecting millions of adults worldwide. For patients who do not find sufficient relief with conservative treatments such as NSAIDs, physical therapy, or weight loss, physicians often recommend intra-articular hyaluronic acid (HA). Among such treatments, ORTHOVISC® stands out as a high molecular weight, non-animal-derived HA product. It is a widely used viscosupplement that aims to restore synovial fluid viscosity and provide symptomatic relief. While ORTHOVISC® is generally safe and well-tolerated, understanding its potential side effects is crucial for both healthcare providers and patients. This article outlines:

• What to expect from ORTHOVISC® therapy, 
• How to monitor for adverse events
• How to support patient safety through informed care

Why Side Effects Happen?

ORTHOVISC® is a non-pharmacologic therapy, composed of highly purified hyaluronan derived from bacterial fermentation. As a substance that closely mimics the natural hyaluronic acid found in healthy joint fluid, it typically integrates well into the joint environment. However, viscosupplementation is not completely free of risk. Side effects may arise due to a variety of factors:

• Joint sensitivity, particularly in joints that are inflamed or severely degenerated

• Injection technique, including improper placement or breach of sterile procedure

• Individual inflammatory response to the foreign HA material introduced into the joint space

Although the majority of potential reactions are usually mild and self-limiting, both patients and healthcare providers must be aware of potential risks.

Common Side Effects (Expected & Mild)

Most of the time, patients tolerate ORTHOVISC® well, with only minor, localized side effects showing after the injection. Those who are trying to chose between Monovisc vs Orthovisc should know that  these reactions are typically temporary and can be managed without professional care.

The most commonly reported side effects include:

• Mild to moderate joint pain following injection
• Temporary stiffness or a sensation of joint tightness
• Local swelling or warmth at the site of administration
• Injection site tenderness, bruising, or redness

All the common side effects listed above usually appear within a few hours after the injection and resolve within 24 to 72 hours. Applying ice, resting the joint, and using over-the-counter analgesics like acetaminophen or NSAIDs (unless contraindicated) can provide significant relief. Patients should be instructed to avoid strenuous activities for at least 48 hours after the injection to minimise irritation.

Less Common but Important Reactions

Besides the common reactions that we already mentioned, some patients may experience certain joint reactions that might be delayed, and even though they are not serious, they can require professional attention. 

These reactions may include: 

• Effusion (increased joint fluid accumulation)
• Inflammatory flares several days after the injection
• Prolonged swelling or discomfort beyond the expected recovery window

These reactions often reflect a transient inflammatory response to the HA material rather than a true allergic or infectious event. Differentiating between a typical post-injection flare and a more concerning adverse reaction depends on the duration, intensity, and accompanying symptoms. For example, mild joint effusion without systemic symptoms can be monitored conservatively, while progressive pain accompanied by redness, warmth, or fever may indicate a more serious complication.

Providers should document these cases carefully and educate patients about the signs that require a return visit and medical assistance.

Rare and Serious Side Effects

Even though they are extremely uncommon, serious adverse events can occur, and when they do, they require immediate medical evaluation. Providers should be prepared to recognise and respond to the following complications:

Septic Arthritis (Infection)

Infection is a rare risk but a serious one, and usually it is caused by improper aseptic technique during the injection process. The symptoms include Severe, persistent joint pain, swelling and redness extending beyond the joint, fever or chills, and a limited range of motion.

Pseudoseptic Reaction

The condition refers to a non-infectious inflammatory response that mimics septic arthritis but does not come from a microbial cause. It can usually be noticed within the first 72 hours after the injection and it is characterised by pain and swelling, warmth at the injection site, and absence of fever or systemic illness. Pseudoseptic reactions are usually self-limiting, but corticosteroid treatment may be required in more severe cases.

Allergic Reactions

True allergic reactions to ORTHOVISC® are extremely rare, especially since it is non-animal derived and produced via bacterial fermentation. Nevertheless, hypersensitivity may present as:

• Rash or urticaria
• Breathing difficulties (anaphylaxis, in very rare cases)

What Providers Should Monitor Post-Injection

Proactive monitoring plays a key role in minimising risk and managing patient expectations. Providers should:

• Observe patients immediately after injection for 15–30 minutes, especially during the first treatment
• Reinforce aseptic technique, using sterile gloves and disinfectants to reduce infection risk
• Document patient history, including prior reactions to hyaluronic acid products, joint infections, or allergies
• Schedule follow-up calls or visits within a week of the injection to assess possible outcomes
• Encourage patients to report any symptoms that worsen after 72 hours

What Patients Should Know and Report

For patients undergoing ORTHOVISC® injections, education is the key solution for safe treatment. Even though their key question might be how long do ORTHOVISC injections last (and that is up to 6 months), healthcare providers should inform patients about:

• The reactions that are perfectly normal. As we already mentioned, those are mild joint pain, swelling, or stiffness for 1–3 days, as well as slight redness or warmth around the injection site. 
• When to call the doctor. Medical attention is absolutely required when a patient experiences severe pain that does not improve or even worsens, fever, significant redness or drainage at the injection site, or swelling that interferes with sleeping or walking. 

How to Minimise Risk

Successful treatments with ORTHOVISC® injections definitely depend on proper administration,  but they also rely on the selection of the right patients and ensuring proper post-injection care. The following strategies can reduce the occurrence of side effects:

• Use ultrasound guidance when appropriate for accurate intra-articular delivery
• Avoid injections in patients with active skin infections, recent joint surgery, or known hypersensitivity
• Instruct patients to avoid high-impact activities for 48–72 hours post-injection
• Provide clear aftercare protocols, including signs of infection, flare, and signs that show when to seek help

Conclusion

ORTHOVISC® is a well-known treatment for knee osteoarthritis which offers significant pain relief and functional improvement for patients who are unresponsive to conservative therapies. While most side effects are mild and temporary, a thoughtful and proactive approach to patient education, monitoring, and care can ensure that both providers and patients navigate the treatment safely. Once they make a treatment plan with their patients, physicians can order Orthovisc at the Best Buy Fillers online store. 

References: 

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

Patient Information ORTHOVISC® High Molecular Weight Hyaluronan. https://www.accessdata.fda.gov/cdrh_docs/pdf3/p030019d.pdf

Neustadt D, Caldwell J, Bell M, Wade J, Gimbel J. Clinical effects of intraarticular injection of high molecular weight hyaluronan (Orthovisc) in osteoarthritis of the knee: a randomized, controlled, multicenter trial. The Journal of Rheumatology. 2005;32(10):1928-1936.