Criteria for Viscosupplementation (Hyaluronic Acid / Hylan G-F 20) for Osteoarthritis of the Knee
Exclusion Criteria
- Known hypersensitivity or allergy to hyaluronate or hylan preparations (applies to all hyaluronic acid and hylan products)
- Knee joint infection, skin disease or infection in the area of the injection site (applies to all hyaluronic acid and hylan products)
Inclusion Criteria
- Documented symptomatic (pain/stiffness) OA of the knee which interferes with functional activities (e.g., ambulation, prolonged standing) and/or is associated with significant pain (applies to all hyaluronic acid and hylan products)
- Adequate trial (2 to 3 months) of non-pharmacologic measures (e.g., cane/crutches, bracing/orthotics, weight loss, physical therapy/exercise) has not resulted in adequate improvement in pain/function (applies to all hyaluronic acid and hylan products)
- Therapeutic trial of at least 3 analgesics (e.g., acetaminophen, topical capsaicin or topical NSAIDs, oral NSAIDs or duloxetine) has not resulted in adequate improvement in pain/function; OR patient is unable to tolerate or is not a candidate for NSAIDs or other oral therapies (applies to all hyaluronic acid and hylan products)
- Patient and/or provider have elected to continue conservative (nonsurgical) treatment for OA (applies to all hyaluronic acid and hylan products)
Administration, Monitoring, and Drug-Specific Considerations
- Use limited to specialists in Orthopedics, Rheumatology, and Physical Medicine and Rehabilitation (applies to all hyaluronic acid and hylan products)
- All hyaluronic acid or hylan products are for intra-articular use only (applies to all hyaluronic acid and hylan products)
- Patients with more advanced stages of OA and near complete loss of joint space may be less likely to benefit from therapy (applies to all hyaluronic acid and hylan products)
- Avian source products (Gel-One, Hyalgan, Supartz, Synvisc, Synvisc-One): Administer with caution in patients with a known allergy to avian proteins, feathers, or eggs
- Non-avian source products (Durolane, Euflexxa, Gel-Syn 3, GenVisc 850, Hymovis, Monovisc, Orthovisc, Synojoynt, Trivisc): Can be used in patients with an allergy to avian proteins
- Safety/efficacy of concomitant administration with other intra-articular agents has not been established (applies to all hyaluronic acid and hylan products)
- Pseudosepsis or severe acute inflammatory reactions (SAIR) reported specifically with Synvisc, typically occurring with the second or third injection in a course or with subsequent courses
- Repeat courses should not be administered within 6 months of the last injection (applies to all hyaluronic acid and hylan products)