Orthovisc is a brand of hyaluronan, a natural complex sugar that functions as a lubricant and shock absorber in healthy joints. Administered as an intra-articular injection, Orthovisc aims to supplement the reduced synovial fluid in arthritic knee joints, thereby lessening pain and improving function in patients with osteoarthritis who have not responded to other therapies like acetaminophen, exercise, or physical therapy. Before considering this treatment, it is imperative for patients and healthcare providers to review the specific circumstances under which Orthovisc should not be administered.
Key Contraindications for Orthovisc
Allergic Reactions and Hypersensitivity
One of the most significant contraindications for Orthovisc is a history of hypersensitivity or allergic reactions to its components. Patients with known allergies to hyaluronate preparations should not receive this treatment. Additionally, Orthovisc is produced using gram-positive bacterial proteins, so patients with known hypersensitivity to these proteins are also contraindicated. While Orthovisc is non-avian derived, it's worth noting that some other viscosupplementation products are extracted from rooster combs, meaning patients with avian allergies might need to choose a different brand. A qualified healthcare provider should always take a full patient history to rule out these allergies.
Active Infections or Skin Diseases
Orthovisc should not be injected into a knee joint that is actively infected. The presence of an infection or skin disease in the area of the injection site or within the knee joint itself can increase the risk of complications, including septic arthritis. This is a serious infection within the joint that requires immediate medical attention and treatment. Aseptic technique is critical during the injection procedure to minimize this risk. Signs of infection to watch for include persistent warmth, swelling, and redness at the injection site.
Bleeding Disorders
Patients with known systemic bleeding disorders, such as hemophilia, or those taking anticoagulants require careful consideration. The intra-articular injection procedure could increase the risk of bleeding or blood clotting complications. Healthcare providers must assess this risk thoroughly before administering the treatment.
Special Population Considerations
The safety and effectiveness of Orthovisc have not been established in several specific patient groups, meaning it is typically contraindicated in these populations:
- Pregnant or Nursing Women: The effects of Orthovisc on an unborn or nursing baby are unknown. The decision to use Orthovisc in these cases should be discussed with a doctor, weighing the potential benefits against the risks.
- Children Under 21: Orthovisc is not approved for use in individuals younger than 21 years of age.
Precautions During Injection
- Disinfectants: Certain disinfectants containing quaternary ammonium salts can cause the hyaluronic acid in Orthovisc to precipitate. It is crucial to use an appropriate skin preparation agent to avoid this interaction.
- Post-Injection Activity: Patients should avoid strenuous activity and prolonged weight-bearing for at least 48 hours following the injection to ensure proper integration and minimize irritation.
Comparison of Contraindications: Orthovisc vs. Avian-Derived Viscosupplements
Orthovisc's manufacturing process, which uses bacterial cells rather than avian sources, eliminates the risk associated with bird-product allergies that exist for some other hyaluronan injections. The table below highlights key differences.
| Feature | Orthovisc (Non-Avian Source) | Avian-Derived Viscosupplements (e.g., Hyalgan) |
|---|---|---|
| Source of Hyaluronan | Bacterial fermentation | Rooster combs |
| Allergy Risk (Avian) | Minimal to none | Present for patients with known allergies to bird products (eggs, feathers, poultry) |
| Allergy Risk (Bacterial Protein) | Yes, for patients allergic to gram-positive bacterial proteins | Not specified, but product-dependent |
| Risk of Infection | Present for injections into infected sites or joints | Present for injections into infected sites or joints |
| Contraindication: Bleeding Disorders | Caution advised due to bleeding risk | General precaution for invasive joint procedures |
Conclusion
Understanding what are the contraindications for Orthovisc is essential for mitigating risks and ensuring the best possible treatment outcome for patients with knee osteoarthritis. The most critical contraindications include a history of hypersensitivity to hyaluronate or gram-positive bacterial proteins, and the presence of infections or skin diseases in or around the injection site. Orthovisc is also not recommended for special populations such as pregnant or nursing women, or individuals under the age of 21, as safety data has not been established for these groups. Always provide a comprehensive medical history to your healthcare provider to help them determine if Orthovisc is the appropriate and safe treatment option for your condition.
For more detailed information regarding prescribing and patient safety, review the manufacturer’s official documentation.
