Synvisc-One

• Approved Indications
• Osteoarthritis of the Knee: Relief of pain in patients with mild to moderate osteoarthritis of the knee who have failed conservative therapy such as acetaminophen or NSAIDs.
• Joint Lubrication: Used as viscosupplementation to restore normal viscoelastic properties of synovial fluid.
• Off-label / Clinically Accepted Uses
• Osteoarthritis of other large joints (e.g., hip or shoulder) in select cases.
• Adjunct therapy to improve joint mobility and delay progression in patients unsuitable for surgery.

• Adults
• Standard Dose: 20 mg/2 mL per intra-articular injection once weekly for 3 consecutive weeks.
• Some protocols allow a single 6 mL injection (Hylan G-F 20, single-injection formulation) depending on product type.
• Pediatrics / Elderly
• Safety and efficacy not established in patients under 18.
• Elderly patients may follow adult dosing; monitor for increased risk of joint irritation.
• Special Groups
• No dose adjustment necessary for mild to moderate renal or hepatic impairment, as systemic absorption is minimal.
• Administration
• Administered intra-articularly by trained healthcare professionals.
• Ensure joint is free from infection; aspiration of effusion may be performed before injection.
• Avoid vigorous activity for 48 hours post-injection to reduce risk of flare.

Hylan G-F 20 is a cross-linked hyaluronan derivative that supplements the natural synovial fluid in osteoarthritic joints. It restores viscoelasticity, lubrication, and shock absorption, reducing mechanical stress on articular cartilage. Hylan also exhibits anti-inflammatory effects by modulating cytokine activity and inhibiting nociceptive signaling within the joint, resulting in decreased pain and improved joint mobility.

• Absorption: Minimal systemic absorption after intra-articular injection.
• Distribution: Remains primarily within the joint space; gradual diffusion into surrounding tissues.
• Metabolism: Enzymatic degradation by hyaluronidases in synovial fluid.
• Elimination: Cleared locally within the joint and metabolized to water and carbon dioxide; minimal renal or hepatic involvement.
• Onset of Action: Pain relief may occur within one week; full effect often observed by 3–5 weeks post-injection.
• Duration: Symptomatic benefit may persist up to 6 months in some patients.

• Pregnancy: Safety in pregnancy has not been established; use only if clearly indicated.
• Lactation: Unknown if Hylan G-F 20 is excreted in breast milk; caution advised.
• Recommendation: Avoid use unless the potential benefit outweighs risk; no systemic absorption suggests minimal risk.

• Primary Class: Osteoarthritis therapy / Viscosupplement
• Subclass: Intra-articular hyaluronan derivative

• Known hypersensitivity to Hylan G-F 20 or avian proteins (if sourced from rooster combs)
• Active joint infection or septic arthritis
• Skin disease or infection at the injection site
• History of bleeding disorders or anticoagulant therapy precluding joint injection

• Injection-site Reactions: Pain, swelling, warmth, erythema, or effusion may occur; usually resolves in 48–72 hours.
• High-risk Patients: Individuals with severe coagulopathy, immunosuppression, or multiple joint involvement.
• Monitoring: Observe for infection or allergic reactions post-injection.
• Flare-ups: Temporary exacerbation of osteoarthritis symptoms may occur; manage with rest or acetaminophen.

• Common:
• Joint pain or swelling
• Local warmth, redness, or effusion
• Mild transient stiffness
• Serious / Rare:
• Septic arthritis or joint infection
• Severe allergic reaction or anaphylaxis (very rare)
• Timing: Usually within 24–72 hours post-injection; dose-independent

• No significant systemic drug interactions reported due to minimal systemic absorption.
• Concomitant use with NSAIDs or corticosteroids in the joint should be carefully monitored to avoid additive local effects or masking of infection.

• Updated guidelines emphasize single vs. multiple injection regimens, noting single-injection formulations may offer equivalent efficacy.
• Recommendations advise use after failure of conservative therapy (physical therapy, analgesics).
• Safety profile continues to support use in mild-to-moderate knee osteoarthritis with caution in high-risk patients.

• Temperature: Store at 2°C–25°C (36°F–77°F)
• Humidity & Light: Protect from excess moisture and light
• Handling Precautions: Inspect prefilled syringe for particulates; use aseptic technique
• Reconstitution: Not required; use as provided