Single-Injection vs. Multi-Injection HA Products: Which Is Better for Knee OA?
Compare single-injection HA products (Synvisc-One, Monovisc, Durolane) with multi-injection series (Euflexxa, Supartz, Hyalgan) for knee osteoarthritis. Understand the differences and which might work best for you.
By Joint Pain Authority Team
Quick Summary
| Factor | Single-Injection | Multi-Injection Series |
|---|---|---|
| Office visits | 1 | 3-5 (weekly) |
| Convenience | High | Lower |
| Total HA delivered | 6 mL typical | 6-10 mL typical |
| Efficacy | Similar | Similar |
| Duration of relief | ~6 months | ~6 months |
| Common products | Synvisc-One, Monovisc, Durolane, Gel-One | Euflexxa, Supartz FX, Hyalgan, Orthovisc |
Bottom line: Research shows similar outcomes. Choice often depends on scheduling, insurance, and personal preference.
Understanding Your Options
When your doctor recommends hyaluronic acid (HA) injections for knee osteoarthritis, one of the first decisions is whether to use a single-injection product or a multi-injection series.
Both approaches work by restoring lubrication and cushioning to your knee joint. The main differences are in how the treatment is delivered.
Single-Injection Products
How They Work
Single-injection HA products deliver a larger dose in one visit—typically 6 mL of hyaluronic acid. This is possible because these products are usually cross-linked or highly concentrated, allowing them to provide sustained effect from a single administration.
Available Products
| Product | Volume | Molecular Weight | Source |
|---|---|---|---|
| Synvisc-One | 6 mL | High (6M Da) | Avian |
| Monovisc | 4 mL | High | Avian |
| Durolane | 3 mL | Medium-High | Bacterial |
| Gel-One | 3 mL | High | Avian |
Advantages
Considerations
Multi-Injection Series Products
How They Work
Multi-injection products deliver smaller doses over multiple weekly appointments—typically 2-2.5 mL per injection over 3-5 weeks. This provides a more gradual delivery of HA to the joint.
Available Products
| Product | Injections | Volume Each | Total Volume | Source |
|---|---|---|---|---|
| Euflexxa | 3 weekly | 2 mL | 6 mL | Bacterial |
| Supartz FX | 3-5 weekly | 2.5 mL | 7.5-12.5 mL | Avian |
| Hyalgan | 3-5 weekly | 2 mL | 6-10 mL | Avian |
| Orthovisc | 3-4 weekly | 2 mL | 6-8 mL | Avian |
Advantages
Considerations
Does One Work Better Than the Other?
What the Research Says
Clinical studies comparing single-injection and multi-injection HA products have found:
Key Findings:
- Similar efficacy in pain reduction and functional improvement
- Comparable duration of effect (~6 months)
- No consistent winner in head-to-head trials
- Individual response varies - some patients do better with one than the other
Why No Clear Winner?
Several factors explain why both approaches work similarly:
- Total HA delivered is roughly equivalent
- Mechanism of action is the same (joint lubrication)
- Disease modification - neither regenerates cartilage
- Patient factors matter more than product factors
Cost Comparison
Insurance Perspective
Typical Medicare Scenario:
| Factor | Single-Injection | 3-Injection Series |
|---|---|---|
| Product cost | Higher per unit | Lower per unit |
| Office visits | 1 | 3 |
| Injection fees | 1 | 3 |
| Facility fees | 1 | 3 |
| Total cost | Often similar | Often similar |
Out-of-Pocket Impact
For patients with copays:
- Single injection: One copay (e.g., $50-150)
- Three injections: Three copays (e.g., 3 × $20-50 = $60-150)
The totals often end up comparable, but structure varies by insurance plan.
Making Your Choice
Consider Single-Injection If:
Consider Multi-Injection Series If:
Questions to Ask Your Doctor
- What products do you typically use? (Providers often have preferences based on experience)
- Is there a coverage difference with my insurance?
- Do I have any allergies that limit my options?
- How many appointments would each approach require?
- Have you seen different results with different products?
Special Situations
If You Need Both Knees Treated
- Single-injection: Can potentially do both knees in one visit
- Multi-injection: May require 3-5 visits per knee (though some providers do both same day)
If You’ve Tried One Type Before
If you responded well to a multi-injection series, you might consider:
- Staying with that approach
- Trying a single-injection for convenience
- The opposite is also true—poor response to one type doesn’t mean the other won’t work
If You’re New to HA Injections
Many providers start with whatever they have the most experience with. Trust their recommendation—the difference in efficacy between products is minimal.
The Bottom Line
Both Approaches Work
Research consistently shows similar outcomes between single-injection and multi-injection HA products:
- Efficacy: Comparable pain relief and function improvement
- Duration: Both provide ~6 months of relief
- Safety: Both have excellent safety profiles
Your choice should be based on:
- Scheduling constraints
- Insurance coverage
- Allergy status
- Personal preference
- Your provider’s recommendation
Don’t overthink it - the best HA product is one that fits your life and that you’ll follow through with.
Find HA Injection Providers
Locate specialists who can help you choose the right HA product and schedule.
Your information is secure. See our Privacy Policy and Terms of Service.
Thank You!
We've received your request. A provider specialist will contact you within 1-2 business days to help you find the right care.
What happens next?
- 1 We'll verify your insurance coverage
- 2 Match you with quality providers in your area
- 3 Contact you to discuss your options
Questions? Browse our guides:
How to Choose a ProviderReferences
-
Comparison of single vs multiple injection viscosupplementation. PMC. PMC8567800
-
Comprehensive review of HA products for knee OA. Orthopedic Reviews. Full Text
-
NCBI StatPearls: Viscosupplementation. NBK602915
-
CMS LCD L39529. Medicare Coverage Database
Treatment Comparison Updates
Stay informed about different options for managing knee osteoarthritis.
Join 10,000+ readers. No spam.
Related Resources
Topics
Enjoyed this article?
Get more insights like this delivered to your inbox weekly.
Join 10,000+ readers. No spam.