Injection Technique
Injection Technique Video
Optimizing Injection Experience With Synvisc-One®
In this demonstration of viscosupplement injection, the superolateral approach is used for the Synvisc-One injection procedure. In addition, this video also demonstrates a recommended technique for determining needle placement and the C.L.A.S.S. method for injecting Synvisc-One.
Remove any synovial fluid or effusion before injecting SYNVISC/Synvisc-One. Strict adherence to aseptic technique must be followed.
C.L.A.S.S. knee injection process
To successfully administer Synvisc-One, remember C.L.A.S.S.
Clean
After marking the location for the injection, apply alcohol, and swab injection site with hyphenate povidone-iodine preparation (e.g. betadine ®).
* Do not concomitantly use disinfectants containing quaternary ammonium salts for skin preparation because hyaluronan can precipitate in their presence.
Local anesthesia
Numbing the skin with an ethyl chloride spray or lidocaine injection prior to intra-articular injection may help patients feel more comfortable. If ethyl chloride spray is used, the injection site will need to be cleaned again as per instructions above.
Aspirate
Insert the appropriate gauge needle (18- to 20-gauge for Synvisc-One; 18- to 22-gauge for SYNVISC); this needle size optimizes fluid dynamics and may help make aspiration and the injection easier. Aspiration confirms accurate needle placement inside the joint space and allows removal of synovial fluid and effusion.
Remove any synovial fluid or effusion before injecting SYNVISC/Synvisc-One. Strict adherence to aseptic technique must be followed.
SYNVISC/Synvisc-One injection
Inject SYNVISC/Synvisc-One using standard techniques; patients should flex and bend the knee 3 to 4 times following injection.
Do not inject SYNVISC/Synvisc-One extra-articularly, into the synovial tissues, into the fat pad or joint capsule, or intravascularly.
Set patient expectations and post-procedure education
Tell your patients to:
- Avoid putting a lot of strain — such as jogging, lifting or prolonged standing — on the knee for 48 hours after the injection treatment or as recommended
- Care for mild pain or swelling at the injection site by keeping an ice pack on the knee for 10 minutes or as recommended
- Report any side effects to you or their healthcare team
Make sure to remind them that most patients reported pain relief starting at four weeks after treatment for knee osteoarthritis with Synvisc-One or even as early as 1 week with SYNVISC.
Additional resources for your patients
A number of resources are also available for you to share with your knee OA patients. In addition to English, some are available in Spanish and other languages.
Order Synvisc-One® and SYNVISC®
Learn about the different ordering options and how to get next-day delivery with your MySynviscONE® account.
MAT-US-2106837-v1.0-07/2021
Resources for Your Patients
Share these tools to help patients get the most out of their treatment.
MAT-US-2106837-v1.0-07/2021
Indication
SYNVISC® (hylan G-F 20) and SYNVISC-ONE® (hylan G-F 20) are indicated for the treatment of pain in osteoarthritis (OA) of the knee in patients who have failed to respond adequately to conservative nonpharmacologic therapy and simple analgesics, e.g., acetaminophen.
IMPORTANT SAFETY INFORMATION
Important Safety Information
SYNVISC and SYNVISC-ONE are contraindicated in patients with known hypersensitivity to hyaluronan products or patients with infections in or around the target knee. Hypersensitivity reactions including anaphylactic reaction, anaphylactoid reaction, anaphylactic shock and angioedema have been reported for both SYNVISC and SYNVISC-ONE.
Do not concomitantly use disinfectants containing quaternary ammonium salts for skin preparation because hyaluronan can precipitate in their presence. Do not inject SYNVISC or SYNVISC-ONE extra-articularly, into the synovial tissues, into the fat pad or joint capsule, or intravascularly. Some cases of skin necrosis have been reported after intra-articular use of hyaluronic acid. Patients should be instructed to contact their treating physician if signs of skin disorder (such as change of color or open sores) appear.
The safety and efficacy of SYNVISC-ONE in locations other than the knee, or for conditions other than osteoarthritis, or in combination with other intra-articular injectables, or in severely inflamed knee joints have not been established. Use caution when injecting SYNVISC or SYNVISC-ONE in patients allergic to avian proteins, feathers, or egg products; who have evidence of lymphatic or venous stasis in the leg to be treated; or who have severe inflammation in the knee to be treated. Remove any synovial fluid or effusion before injecting SYNVISC or SYNVISC-ONE. Strict adherence to aseptic technique must be followed to avoid joint infection. The safety and effectiveness of SYNVISC and SYNVISC-ONE have not been established in children (≤21 years old) or in pregnant or lactating women. Patients should be advised to avoid strenuous or prolonged weight-bearing activities for approximately 48 hours after treatment.
For SYNVISC
In clinical trials, the most commonly reported adverse events were transient pain, swelling, and/or joint effusion in the injected knee. The following reported adverse events are among those that may occur in association with intra-articular injections, including SYNVISC: arthralgia, joint stiffness, joint effusion, joint swelling, joint warmth, injection site pain, arthritis, arthropathy, and gait disturbance.
View the Complete Prescribing Information for SYNVISC
For SYNVISC-ONE
The most commonly reported adverse events were arthralgia, arthritis, arthropathy, injection site pain, and joint effusion. The following reported adverse events are among those that may occur in association with intra-articular injections, including SYNVISC-ONE: arthralgia, joint stiffness, joint effusion, joint swelling, joint warmth, injection site pain, arthritis, arthropathy, and gait disturbance.
References
-
SYNVISC [prescribing information]. Cambridge, MA: Genzyme Corporation.
-
SYNVISC-ONE [prescribing information]. Cambridge, MA: Genzyme Corporation.
-
Wobig M, Dickhut A, Maier R, Vetter G. Viscosupplementation with hylan G-F 20: a 26-week controlled trial of efficacy and safety in the osteoarthritic knee. Clin Ther. 1998;20(3):410-423.
-
Chevalier X, Jerosch J, Goupille P, et al. Single, intra-articular treatment with 6 ml hylan G-F 20 in patients with symptomatic primary osteoarthritis of the knee: a randomised, multicentre, double-blind, placebo controlled trial. Ann Rheum Dis. 2010;69(1):113-119.
IMPORTANT SAFETY INFORMATION
Read MoreImportant Safety Information
SYNVISC and SYNVISC-ONE are contraindicated in patients with known hypersensitivity to hyaluronan products or patients with infections in or around the target knee. Hypersensitivity reactions including anaphylactic reaction, anaphylactoid reaction, anaphylactic shock and angioedema have been reported for both SYNVISC and SYNVISC-ONE.
Do not concomitantly use disinfectants containing quaternary ammonium salts for skin preparation because hyaluronan can precipitate in their presence. Do not inject SYNVISC or SYNVISC-ONE extra-articularly, into the synovial tissues, into the fat pad or joint capsule, or intravascularly. Some cases of skin necrosis have been reported after intra-articular use of hyaluronic acid. Patients should be instructed to contact their treating physician if signs of skin disorder (such as change of color or open sores) appear.
The safety and efficacy of SYNVISC-ONE in locations other than the knee, or for conditions other than osteoarthritis, or in combination with other intra-articular injectables, or in severely inflamed knee joints have not been established. Use caution when injecting SYNVISC or SYNVISC-ONE in patients allergic to avian proteins, feathers, or egg products; who have evidence of lymphatic or venous stasis in the leg to be treated; or who have severe inflammation in the knee to be treated. Remove any synovial fluid or effusion before injecting SYNVISC or SYNVISC-ONE. Strict adherence to aseptic technique must be followed to avoid joint infection. The safety and effectiveness of SYNVISC and SYNVISC-ONE have not been established in children (≤21 years old) or in pregnant or lactating women. Patients should be advised to avoid strenuous or prolonged weight-bearing activities for approximately 48 hours after treatment.
For SYNVISC
In clinical trials, the most commonly reported adverse events were transient pain, swelling, and/or joint effusion in the injected knee. The following reported adverse events are among those that may occur in association with intra-articular injections, including SYNVISC: arthralgia, joint stiffness, joint effusion, joint swelling, joint warmth, injection site pain, arthritis, arthropathy, and gait disturbance.
View the Complete Prescribing Information for SYNVISC
For SYNVISC-ONE
The most commonly reported adverse events were arthralgia, arthritis, arthropathy, injection site pain, and joint effusion. The following reported adverse events are among those that may occur in association with intra-articular injections, including SYNVISC-ONE: arthralgia, joint stiffness, joint effusion, joint swelling, joint warmth, injection site pain, arthritis, arthropathy, and gait disturbance.
References
-
SYNVISC [prescribing information]. Cambridge, MA: Genzyme Corporation.
-
SYNVISC-ONE [prescribing information]. Cambridge, MA: Genzyme Corporation.
-
Wobig M, Dickhut A, Maier R, Vetter G. Viscosupplementation with hylan G-F 20: a 26-week controlled trial of efficacy and safety in the osteoarthritic knee. Clin Ther. 1998;20(3):410-423.
-
Chevalier X, Jerosch J, Goupille P, et al. Single, intra-articular treatment with 6 ml hylan G-F 20 in patients with symptomatic primary osteoarthritis of the knee: a randomised, multicentre, double-blind, placebo controlled trial. Ann Rheum Dis. 2010;69(1):113-119.