Monovisc for Knee Osteoarthritis: Complete Patient Guide

Key Takeaways

• One-and-done convenience: Single injection instead of multiple visits
• From a trusted name: Made by DePuy Synthes, Johnson & Johnson’s orthopedic division
• 6-month relief: Clinical studies show pain reduction lasting up to 26 weeks
• Important allergy warning: Not safe for people with bird or egg allergies (made from rooster combs)
• Variable insurance coverage: Often requires trying other treatments first (step therapy)

What Is Monovisc?

Monovisc is a single-injection hyaluronic acid (HA) treatment for knee osteoarthritis pain. Unlike older gel shots that require 3-5 weekly injections, Monovisc delivers the full course of treatment in one office visit.

It’s made by DePuy Synthes, part of Johnson & Johnson’s orthopedic division—the same company that makes Orthovisc, a well-established 3-injection HA product.

Think of it as: A one-time cushioning supplement for your knee joint, designed to reduce pain and improve mobility for several months.

Quick Facts About Monovisc

Is Monovisc Right for You?

Monovisc may be a good option if you:

• Have mild to moderate knee osteoarthritis
• Haven’t gotten enough relief from pain medications or physical therapy
• Want to avoid or delay knee surgery
• Prefer a single injection over multiple visits
• Have no allergies to birds, eggs, or feathers
• Are looking for 6+ months of pain relief

You should NOT use Monovisc if:

• You’re allergic to birds, eggs, feathers, or poultry products
• You have an infection in or around your knee
• You have skin problems around the injection site
• You’re allergic to gram-positive bacterial proteins

Always discuss your complete medical history with your doctor before starting any treatment.

How Monovisc Works

Your knee joint naturally contains hyaluronic acid, a thick fluid that acts as a shock absorber and lubricant. Osteoarthritis breaks down this natural cushioning, leading to bone-on-bone friction, pain, and stiffness.

Monovisc works by:

1. Restoring cushioning: Replenishes the natural gel-like fluid in your knee
2. Reducing friction: Lubricates the joint surfaces so they glide more smoothly
3. Decreasing inflammation: May have anti-inflammatory effects that reduce pain signals
4. Protecting cartilage: Creates a protective layer over remaining cartilage

What makes Monovisc different: Its high molecular weight and cross-linked structure help it stay in the joint longer than some other HA products, allowing for single-injection convenience.

What to Expect: The Monovisc Procedure

Before Your Injection

• Your doctor will examine your knee and review your medical history
• You may need recent X-rays to confirm osteoarthritis diagnosis
• Be sure to mention any allergies, especially to birds or eggs
• Ask if you should stop any medications (like blood thinners)

During the Injection

The procedure typically takes 10-15 minutes:

1. Positioning: You’ll sit or lie down with your knee slightly bent
2. Cleaning: The injection site is thoroughly cleaned and sterilized
3. Numbing (optional): Some doctors use a local anesthetic
4. Fluid removal (if needed): Excess joint fluid may be drained first
5. Injection: Monovisc is injected directly into the knee joint
6. Imaging guidance (optional): Some doctors use ultrasound or fluoroscopy to ensure precise placement

Does it hurt? Most patients report brief pressure or mild discomfort during the injection, similar to getting blood drawn. The procedure itself is quick.

After Your Injection

• Rest your knee for 24-48 hours
• Avoid strenuous activities for 2 days
• Apply ice if you have swelling
• You can usually resume normal activities after 48 hours
• Pain relief typically begins within 2-4 weeks

How Effective Is Monovisc?

Clinical research shows Monovisc can provide meaningful pain relief for many patients:

What the Studies Show

• Pain reduction: Clinical trials found 40-50% reduction in pain scores at 6 months
• Improved function: Patients reported better mobility and daily activities
• Duration: Relief typically lasts 5-6 months, though some patients get up to a year
• Comparable to multi-injection HA: Studies show similar effectiveness to 3-injection products

Real-World Expectations

Who responds best:

• People with mild to moderate osteoarthritis (Kellgren-Lawrence grade 2-3)
• Patients under 75 years old
• Those with no major joint deformity
• People who maintain a healthy weight

Response varies: About 60-70% of patients get significant relief, while 20-30% see minimal benefit. Unfortunately, there’s no way to predict who will respond well before trying it.

Side Effects and Risks

Most side effects are mild and temporary. Here’s what to watch for:

Common Side Effects (10-15% of patients)

• Pain, swelling, or warmth at injection site
• Temporary increase in knee pain (first 24-48 hours)
• Bruising around the injection area
• Joint stiffness

These usually resolve within 2-3 days.

Less Common but Serious

• Infection (rare, less than 1%): Increased pain, redness, warmth, fever
• Allergic reaction: Rash, itching, difficulty breathing (very rare)
• Bleeding or bruising: Higher risk if you take blood thinners

When to call your doctor:

• Severe pain that worsens after 2 days
• Fever or chills
• Significant swelling or redness
• Signs of allergic reaction

Critical Allergy Warning: Bird and Egg Allergies

IMPORTANT: Monovisc is made from rooster combs (avian source). Do NOT use Monovisc if you have:

• Bird allergies (chickens, turkeys, other poultry)
• Egg allergies
• Feather allergies
• Previous reactions to avian-derived products

Why this matters: The manufacturing process uses proteins from roosters. Even though highly purified, trace amounts may remain and trigger allergic reactions.

Alternatives for those with bird allergies:

• Synvisc/Synvisc-One: Also avian-derived (not suitable)
• Euflexxa, Supartz, Visco-3: Bacterial fermentation (bird-allergy safe)
• Gel-One: Avian-derived (not suitable)

Always tell your doctor about ALL allergies before getting any HA injection.

Insurance Coverage and Cost

Medicare Coverage

Medicare Part B covers Monovisc when:

• You have documented knee osteoarthritis
• Conservative treatments haven’t provided adequate relief
• Your doctor documents medical necessity

What you’ll pay with Medicare:

• 20% coinsurance after Part B deductible
• Typically $100-$200 out-of-pocket

Private Insurance

Coverage varies significantly:

• Many plans cover: With prior authorization and step therapy requirements
• Step therapy: May require trying 3-injection products first
• Some plans don’t cover: View single-injection products as “convenience” rather than medical necessity

Always verify coverage BEFORE your appointment. Call your insurance and ask:

1. “Is Monovisc covered for knee osteoarthritis?”
2. “What’s my copay or coinsurance?”
3. “Do I need prior authorization?”
4. “Is there step therapy—do I need to try other treatments first?”

Self-Pay Costs

If you’re paying out of pocket:

Some clinics offer payment plans or cash-pay discounts.

Monovisc vs. Orthovisc: Same Company, Different Approach

Interestingly, DePuy Synthes (Johnson & Johnson) makes BOTH Monovisc and Orthovisc. Here’s how they compare:

Why does J&J make both? Different patients have different preferences:

• Choose Monovisc if: Convenience is your top priority
• Choose Orthovisc if: Your insurance requires step therapy, or you prefer gradual treatment

The effectiveness is similar—it often comes down to convenience and insurance coverage.

Monovisc vs. Other Single-Injection Options

If you want single-injection convenience, here are your main options:

Insurance perspective: Some insurers prefer multi-injection products as “first-line” and require you to try those before approving single-injection options.

Frequently Asked Questions

How long does it take for Monovisc to work?

Most patients notice improvement within 2-4 weeks after injection. Full benefit typically develops by 8-12 weeks. If you see no improvement after 12 weeks, it’s unlikely to work for you.

How long does Monovisc last?

Clinical studies show pain relief lasting 5-6 months on average. Some patients get up to a year of relief, while others may only get 3-4 months. You can repeat the injection when pain returns.

Can I get Monovisc in both knees?

Yes, but insurance and Medicare typically require separate injections on different days (usually 1-2 weeks apart). Some doctors prefer treating one knee at a time to monitor your response.

Is Monovisc better than cortisone shots?

Different purposes:

• Cortisone: Fast relief (1-2 days) but shorter duration (4-8 weeks). Better for acute flares.
• Monovisc: Slower onset (2-4 weeks) but longer duration (5-6 months). Better for ongoing management.

Many patients try cortisone first for quick relief, then transition to Monovisc for longer-term management.

Can I exercise after Monovisc?

Yes, but timing matters:

• First 48 hours: Rest, avoid strenuous activity
• Week 1-2: Light activities (walking, gentle stretching)
• After 2 weeks: Gradually return to normal exercise
• After 4 weeks: Full activity once pain improves

Physical therapy and low-impact exercise often enhance Monovisc’s effectiveness.

Will I need repeat injections?

Probably. Monovisc doesn’t cure arthritis—it manages symptoms. Most patients need repeat injections every 6-12 months. There’s no limit to how many times you can repeat treatment.

Does the injection hurt?

Most patients describe brief pressure or mild discomfort during injection. The needle itself causes less pain than the sensation of fluid entering the joint. Any post-injection pain typically resolves within 1-2 days.

What if Monovisc doesn’t work for me?

If you don’t get relief after 12 weeks, discuss alternatives with your doctor:

• Try a different HA brand (different molecular weight may work better)
• Consider cortisone injections for acute relief
• Explore other treatments (PRP, physical therapy, bracing)
• Discuss surgical options if conservative treatments fail

Is Monovisc safe for people with diabetes?

Yes, Monovisc is generally safe for diabetics. However, cortisone shots (sometimes given before HA) can temporarily raise blood sugar. If you have diabetes, monitor your glucose levels after any knee injection.

Can I drive after getting Monovisc?

Most patients can drive immediately after injection, but some doctors recommend having someone drive you home, especially if you received sedation or if your driving leg was injected.

Next Steps: Getting Started with Monovisc

If you’re interested in Monovisc:

1. Talk to your doctor about whether you’re a good candidate
2. Disclose all allergies, especially birds, eggs, or feathers
3. Verify insurance coverage and any step therapy requirements
4. Ask about imaging guidance (ultrasound or fluoroscopy for accuracy)
5. Plan for 48 hours of rest after your injection
6. Set realistic expectations: Relief takes 2-4 weeks, not everyone responds

The Bottom Line

Monovisc offers the convenience of single-injection HA therapy from a trusted manufacturer (Johnson & Johnson). Clinical evidence supports its effectiveness for mild to moderate knee osteoarthritis, with pain relief lasting 5-6 months for most patients.

Best for: Patients who value convenience, have no bird allergies, and whose insurance covers single-injection products.

Consider alternatives if: You have bird/egg allergies, your insurance requires step therapy, or you prefer gradual treatment with multiple injections.

The key is finding what works for YOUR knees, YOUR insurance, and YOUR lifestyle. Monovisc is one proven option worth discussing with your healthcare provider.

Medical Disclaimer: This information is for educational purposes only and does not replace professional medical advice. Always consult with a qualified healthcare provider before starting any treatment. Only your doctor can determine if Monovisc is appropriate for your specific condition.

Allergy Disclaimer: Monovisc contains materials derived from avian sources (rooster combs). Do not use if you have allergies to birds, eggs, feathers, or poultry products. Serious allergic reactions, including anaphylaxis, can occur.

Last medically reviewed: January 2025