Orthovisc for Knee Osteoarthritis: Complete Patient Guide

Key Takeaways

• High molecular weight formula (1,000-2,900 kDa) mimics the natural concentration of healthy joint fluid
• 3-4 weekly injections provide sustained knee pain relief for osteoarthritis
• Made from avian sources (rooster combs) - not suitable if you have bird/egg allergies
• Typically covered by Medicare and commercial insurance ($100-$250 with insurance, $600-$900 without)
• Manufactured by DePuy Synthes (Johnson & Johnson), a trusted name in orthopedic medicine

What Is Orthovisc?

Orthovisc is a viscosupplementation treatment for knee osteoarthritis—a series of gel injections that restore the cushioning and lubrication in your knee joint. Think of it as replenishing what arthritis has worn away.

The product contains ultra-pure, high molecular weight hyaluronic acid (HA) extracted from rooster combs. Unlike some newer synthetic formulations, Orthovisc’s naturally-derived, high molecular weight formula closely resembles the healthy synovial fluid found in young, healthy knees.

Manufacturer Background

Orthovisc is made by DePuy Synthes, the orthopedic division of Johnson & Johnson—one of the world’s most trusted medical device companies. The same company also manufactures Monovisc, a single-injection version of the treatment.

Having a major pharmaceutical company behind the product means:

• Rigorous quality control and manufacturing standards
• Extensive clinical research and safety data
• Consistent product availability
• Strong post-market surveillance

Quick Facts

Is Orthovisc Right for You?

Orthovisc may be a good option if you:

• Have been diagnosed with knee osteoarthritis
• Haven’t found adequate relief from conservative treatments (physical therapy, weight management, over-the-counter pain relievers)
• Want to avoid or delay knee replacement surgery
• Prefer a naturally-derived treatment with a proven track record
• Are looking for Medicare-covered treatment options

Important Considerations

Orthovisc may NOT be appropriate if you:

• Have allergies to birds, feathers, or eggs (avian-source products can trigger allergic reactions)
• Have an active knee infection or skin disease around the injection site
• Have significantly advanced arthritis (bone-on-bone) where there’s no remaining joint space

Allergy Warning: Because Orthovisc is derived from rooster combs, patients with avian (bird), feather, or egg allergies should avoid this product. Discuss alternatives like Synvisc (bacterial fermentation) or Durolane (bacterial fermentation) with your doctor.

How Orthovisc Works

High Molecular Weight Advantage

What sets Orthovisc apart is its high molecular weight hyaluronic acid (1,000-2,900 kDa). Here’s why that matters:

Natural Joint Fluid Mimicry: Healthy knee joints contain HA with a molecular weight range of 1,000-4,000 kDa. Orthovisc’s formulation falls squarely within this natural range, meaning it closely replicates what your body produces when you’re young and healthy.

Enhanced Viscoelastic Properties: Higher molecular weight HA provides:

• Better shock absorption during impact activities (walking, climbing stairs)
• Superior lubrication between joint surfaces
• Longer residence time in the joint (stays where it’s needed)

Mechanism of Action

Orthovisc works through multiple pathways:

1. Mechanical cushioning - Restores the protective gel layer between bones
2. Anti-inflammatory effects - Helps reduce joint inflammation
3. Chondroprotection - May protect remaining cartilage from further breakdown
4. Pain receptor modulation - Reduces pain signal transmission

Think of it as giving your knee joint the natural cushioning it’s lost to arthritis, allowing for smoother, less painful movement.

The 3-Visit Treatment Protocol

Treatment Schedule

Standard protocol: 3 injections, one week apart

Some physicians may recommend a 4-injection series for more severe osteoarthritis. Your doctor will determine the right protocol based on your specific condition.

What to Expect at Each Visit

Week 1 - First Injection:

• Your knee is cleaned and sometimes numbed with a local anesthetic
• If you have excess fluid (effusion), your doctor may drain it first
• The Orthovisc injection takes just a few minutes
• You may feel pressure or mild discomfort during injection

Week 2 - Second Injection:

• Same process as the first visit
• Some patients begin noticing subtle improvements

Week 3 - Third Injection:

• Final injection completes the treatment course
• Most patients begin experiencing more noticeable pain relief within 2-4 weeks after completing the series

Post-Injection Care

After each injection:

• Avoid strenuous activities for 48 hours (no running, heavy lifting, prolonged standing)
• Light walking is encouraged
• Apply ice if you experience swelling
• Report any signs of infection (increasing pain, warmth, redness, fever) immediately

Effectiveness: What the Research Shows

Clinical Evidence

Clinical studies demonstrate that Orthovisc provides meaningful pain relief for many patients with knee osteoarthritis:

• Pain reduction: Studies show 30-50% reduction in pain scores compared to baseline
• Improved function: Patients report better mobility and quality of life
• Duration: Relief typically lasts 3-6 months, with some patients experiencing benefits up to 12 months
• Safety profile: Generally well-tolerated with minimal serious adverse events

Real-World Effectiveness

It’s important to understand that individual results vary significantly:

Best results typically seen in:

• Mild to moderate osteoarthritis (Kellgren-Lawrence grades 1-3)
• Patients who complete the full injection series
• Those who combine treatment with appropriate weight management and exercise

Less effective for:

• Advanced bone-on-bone arthritis (grade 4)
• Patients with inflammatory arthritis (rheumatoid arthritis)
• Knees with significant structural damage or deformity

Realistic Expectations

Orthovisc is not a cure for arthritis, nor does it restore damaged cartilage. What it can do is:

• Reduce pain and stiffness
• Improve mobility and function
• Potentially delay the need for knee replacement
• Buy time for you to maintain an active lifestyle

Side Effects and Safety

Common Side Effects

Most patients tolerate Orthovisc well, but some experience:

Injection site reactions (most common):

• Mild pain or swelling at the injection site
• Temporary stiffness
• Warmth or redness
• Fluid accumulation (effusion)

These typically resolve within a few days.

Less Common but Serious Reactions

Seek medical attention if you experience:

• Severe pain that worsens after injection
• Significant swelling or warmth (possible infection)
• Fever or chills
• Allergic reaction symptoms (rash, difficulty breathing, facial swelling)

Allergic reactions: While rare, patients with avian allergies can have serious reactions to rooster comb-derived products. This is why pre-screening for bird/egg allergies is crucial.

Contraindications

Do not use Orthovisc if you:

• Have known allergies to birds, feathers, or egg products
• Have an infection in or around the knee joint
• Have severe inflammation (acute flare-up)

Insurance Coverage and Cost

Medicare Coverage

Orthovisc is typically covered by Medicare Part B when:

• You have a documented diagnosis of knee osteoarthritis
• Conservative treatments have been tried without adequate relief
• The treatment is deemed medically necessary by your physician

Medicare typically pays 80% of the approved amount after you meet your deductible. You’re responsible for the remaining 20% coinsurance.

Commercial Insurance

Most major insurance plans cover Orthovisc as a medically necessary treatment for knee osteoarthritis. Coverage details vary by plan, so verify with your insurance provider.

Out-of-Pocket Costs

Without insurance: $600-$900 for the complete 3-injection series

With insurance: $100-$250 per treatment course (after deductible and coinsurance)

Cost factors:

• Geographic location (urban areas tend to be more expensive)
• Provider type (hospital outpatient vs. physician office)
• Whether imaging guidance (fluoroscopy) is used
• Your specific insurance plan

Billing codes: Orthovisc is typically billed under HCPCS code J7324 for Medicare claims.

Orthovisc vs. Monovisc: Same Company, Different Protocols

Johnson & Johnson’s DePuy Synthes makes both Orthovisc and Monovisc. Here’s how they compare:

Which Is Better?

There’s no definitive answer—both are effective options from the same trusted manufacturer:

Choose Orthovisc if:

• You prefer a gradual treatment approach with multiple visits
• Your insurance covers multi-injection series with lower copays per visit
• Your doctor recommends staggered dosing for your condition

Choose Monovisc if:

• You value convenience and want to minimize office visits
• You’re willing to pay slightly more for single-injection convenience
• Your doctor believes a single higher-volume injection is appropriate

Both contain the same high-quality, high molecular weight hyaluronic acid—the main difference is delivery protocol.

Frequently Asked Questions

How long does Orthovisc take to work?

Most patients begin experiencing pain relief 2-4 weeks after completing the 3-injection series. Some notice improvements sooner, while others take up to 8 weeks. Peak effectiveness typically occurs around 8-12 weeks after treatment.

Can I get Orthovisc injections more than once?

Yes. Many patients receive repeat treatment courses when the effects wear off, typically 6-12 months after the initial series. There’s no established limit on the number of courses you can receive, though your doctor will reassess your condition before each new series.

Is Orthovisc better than cortisone shots?

They serve different purposes:

• Cortisone provides rapid but short-term relief (4-8 weeks), best for acute flare-ups
• Orthovisc takes longer to work but provides longer-lasting relief (3-6+ months)

Many doctors use cortisone for immediate pain control while waiting for viscosupplementation to take effect.

Does the injection hurt?

Most patients describe the injection as mild pressure or discomfort rather than severe pain. The needle itself causes a brief pinch, and you may feel pressure as the gel enters the joint. Some doctors use a local anesthetic to numb the area first.

Can I have Orthovisc in both knees?

Yes. If both knees have osteoarthritis, you can receive Orthovisc in both. However, doctors typically treat one knee at a time (different weeks) to avoid bilateral post-injection symptoms that could affect mobility.

What if I’m allergic to birds or eggs?

Do not use Orthovisc if you have avian allergies. Instead, ask your doctor about non-avian alternatives:

• Synvisc/Synvisc-One (bacterial fermentation source)
• Durolane (bacterial fermentation source)
• Gel-One (bacterial fermentation source)

Will Orthovisc help bone-on-bone arthritis?

Results are less predictable in severe, bone-on-bone arthritis where there’s minimal remaining joint space. Viscosupplementation works best with mild to moderate osteoarthritis where some cartilage and joint space remain.

Can I exercise after Orthovisc injections?

Light activity like walking is encouraged immediately. Avoid:

• High-impact activities (running, jumping) for 48 hours
• Heavy lifting or strenuous exercise for 48 hours
• Prolonged standing or kneeling for 48 hours

After the 48-hour rest period, gradually resume normal activities as tolerated.

The Bottom Line

Orthovisc offers a proven, Medicare-covered option for knee osteoarthritis relief, backed by Johnson & Johnson’s reputation for quality and safety. Its high molecular weight formula closely mimics natural joint fluid, providing the cushioning and lubrication your knee needs.

The 3-visit protocol requires a time commitment, but many patients find the extended relief (3-6+ months) worth the investment. If you value convenience over multiple visits, ask your doctor about Monovisc, the single-injection alternative from the same manufacturer.

Is Orthovisc right for you? That depends on your specific condition, insurance coverage, allergy history, and treatment goals. Schedule a consultation with a qualified physician to discuss whether viscosupplementation—and Orthovisc specifically—makes sense for your situation.

Important Disclaimer: This information is for educational purposes only and does not constitute medical advice. Orthovisc is a prescription medical device that must be administered by a qualified healthcare provider. Individual results vary. Discuss the risks, benefits, and alternatives with your doctor before starting any treatment for knee osteoarthritis.

Not safe for patients with avian (bird), feather, or egg allergies. Always disclose your complete allergy history to your healthcare provider.

Last reviewed: January 2025