Monovisc vs Synvisc: The Better Osteoarthritis Treatment

Osteoarthritis is a degenerative, multifactorial condition that affects the joint, particularly the knee joint. Affecting more than 27 million adults in the United States alone, osteoarthrosis is the most prevalent type of arthritis.

Osteoarthritis is progressive in nature, which means its symptoms are likely to worsen over time. Eventually, patients may find it hard to perform daily activities such as walking and climbing stairs. In severe cases, patients may even have difficulty standing.

Currently the major treatment modalities for osteoarthritis are pharmacotherapies (e.g. acetaminophen, narcotics, nonsteroidal anti-inflammatory agents and corticosteroids), exercise, and physical therapy. Removing excess joint fluid and avoiding known triggers of knee pain (e.g. physical activities) may also help to alleviate osteoarthritis. Additionally, viscosupplements such as Monovisc and Synvisc are frequently used as second-line treatments for patients who do not respond adequately to conventional therapies.

Monovisc and Synvisc as viscosupplements

Synvisc and Monovisc are popular brands of viscosupplements. Synvisc is developed and produced by Sanofi S.A., a French pharmaceutical corporation with a global presence. Monovisc, on the other hand, is a product of the Massachusetts-based Anika Therapeutic Inc. Both Synvisc and Monovisc are hyaluronic acid-based orthopedic injectables.

Why choose viscosupplements?

While first-line treatments such as analgesics and exercise work fine for many patients, some people fail to obtain adequate pain relief from these conservative treatments. Viscosupplements such as Synvisc and Monovisc are useful alternatives for osteoarthritis management when all other treatment modalities fail. Through its cushioning effects, Synvisc and Monovisc effectively absorb shock to allow smoother movements between the bones. This dramatically reduces pain in the knee, helping patients to improve their quality of life.

What to expect with treatment

Synvisc and Monovisc should be administered via intraarticular injections. Prior to injection, it is important to get rid of any excess fluid in the knee joint. Ideally the injection site should free from any infection and skin disease. As with most hyaluronic acid injectables, Synvisc and Monovisc should be administered by qualified medical professionals.

Monovisc and Synvisc: Are they the same thing?

Despite having the same indication, there are some differences between the two orthopedic injectables. For example, Monovisc is supplied with a hyaluronic acid concentration of 88mg/4ml, whereas Synvisc is available with a hyaluronic acid concentration of 16mg/2ml. As well, they have different dosing schedules. When using Monovisc, 4ml of the product should be administered as a single injection. As for Synvisc, it is recommended to perform one injection each week for three weeks consecutively (2ml for each injection). Synvisc, however, is also available as a single injection treatment, called Synvisc-One.

Containing the same active ingredient, Monovisc and Synvisc have similar side effect profiles. While generally well tolerated, both Monovisc and Synvisc can potentially cause injection site reactions such as swelling, pain, stiffness, warmth, fluid buildup in the knee, and puffiness.

The hyaluronic acid in the two formulations have different sources and different properties. Synvisc is derived from rooster combs; therefore, there is a risk of avian allergy. To avoid undesirable reactions, Synvisc should not be used if patients have allergies to egg products, feathers or bird proteins. Monovisc, on the other hand, consists of non-pyrogenic hyaluronan originated from bacterial cells.

Monovisc and Synvisc:  Which is better?

Both treatments offer relief from pain associated with osteoarthritis. Due to the different formulations, the most suitable viscosupplement may need to be determined by the concentration and origin of the hyaluronic acid. Discuss your needs and expectations with your doctor to determine which treatment is most suitable.


Affecting millions of people globally, osteoarthritis is a, multifactorial, highly disabling disease that mostly occur in the knee joint. In fact, osteoarthritis is ranked as the 11th most disabling disease worldwide. As it progresses, osteoarthritis will impact the ability to walk and stand, significantly disrupting patient functionality. While first-line treatments such as exercise and pharmacotherapies may be useful for pain relief, they do not always work. Viscosupplements such as Monovisc and Synvisc serve as the perfect alternatives to these conventional treatments. Being the second line treatment, viscosupplementation is usually reserved for patients who fail to achieve satisfactory pain relief from first-line treatments. While the use of viscosupplements remain controversial, it is undeniable that they are useful in patients with unresolved osteoarthritis knee pain.