Cingal and Monovisc

What is hyaluronic acid?

Hyaluronic acid is naturally present within healthy joint fluid. It helps the surfaces of the joint move smoothly and contributes to the cushioning and lubrication of the joint.

Osteoarthritis can affect the quality of this natural joint fluid, as well as the cartilage, bone and surrounding tissues.

Hyaluronic acid injections place a manufactured form of the substance directly into the joint. This treatment is sometimes referred to as viscosupplementation.

The treatment is intended to help manage pain, stiffness and reduced function in selected patients. It does not reverse the underlying arthritis.

What is Monovisc?

Monovisc is a single-injection hyaluronic acid treatment used for pain associated with knee osteoarthritis.

It contains a high dose of lightly cross-linked hyaluronic acid in a single 4 ml injection. Unlike a corticosteroid injection, Monovisc does not contain a steroid.

Monovisc may be considered for patients who would like to explore a non-steroid injection option, particularly where pain and stiffness are making walking, exercise or rehabilitation more difficult.

The effect is not usually immediate. Improvement may develop gradually over the following weeks, and the amount and duration of relief can vary between patients, although around 70% of patients respond positively to treatment, improving function and movement while reducing pain significantly

What is Cingal?

Cingal combines the same high-dose hyaluronic acid used in Monovisc with a small amount of triamcinolone hexacetonide, a fast-acting corticosteroid.

The corticosteroid component is included to help settle inflammation and provide earlier pain relief. The hyaluronic acid component is intended to provide more sustained symptom relief as the steroid effect reduces. This allows the patient to feel pain relief and get back to activity within 48 hours in some cases.

Cingal may be considered where osteoarthritis is associated with pain, stiffness or inflammation and there is a benefit in combining both treatments within a single injection. Cingal is the only treatment to combine both proven options.  It also enhances joint health for the long term, removing associated concerns with repeated steroid injections.

Over 90% of patients respond positively to Cingal injections. 

Cingal or Monovisc: what is the difference?

The main difference is that Cingal contains a corticosteroid and Monovisc does not.

Monovisc may be more suitable where:

• A non-steroid option is preferred
• There is no significant inflammatory flare
• Previous hyaluronic acid treatment has been helpful
• A more gradual response is acceptable

Cingal may be considered where:

• There is a more inflammatory or irritated joint (often called synovitis)
• Earlier pain relief would be helpful
• Symptoms are significantly restricting movement or rehabilitation
• A combined steroid and hyaluronic acid treatment is appropriate

Neither option is automatically better. The decision depends on the condition of the knee, previous treatment, medical history and what the patient is hoping to achieve.

Who might benefit from treatment?

Cingal or Monovisc may be considered for adults with joint pain from  osteoarthritis who are experiencing:

• Pain when walking or using stairs
• Stiffness after rest
• Reduced ability to exercise
• Difficulty progressing with strengthening or physiotherapy
• Recurrent irritation or swelling
• Ongoing symptoms despite activity changes, medication or rehabilitation
• A wish to delay or avoid more invasive treatment where appropriate

The severity of arthritis on an X-ray does not always match the level of pain. Treatment decisions are therefore based on the whole clinical picture rather than the scan alone.

What happens during the procedure?

The injection is given directly into the knee joint.

Dr Al Jones may use ultrasound guidance to improve accuracy and confirm that the treatment is delivered into the intended area.

Where there is significant fluid within the knee, some of this may be removed before the injection if clinically appropriate.

The appointment will also include a discussion about the likely benefits, possible risks, expected recovery and what activity is advised afterwards.

How quickly will it work?

Cingal may provide earlier relief because it contains a corticosteroid. Some patients notice a change within the first few days.

Monovisc usually has a more gradual onset and may take several weeks to have an effect.

With either treatment, individual responses vary. Some patients achieve a meaningful reduction in pain and stiffness, while others notice a smaller improvement or no clear benefit.

No injection can guarantee a specific result or duration of relief.

How long can the benefit last?

The benefit from hyaluronic acid treatment may continue for several months in patients who respond well.

Clinical studies of Cingal and Monovis have demonstrated pain improvement beyond six months. Some patients report 9 to 12 months, but this should not be assumed for everyone.

Can the injections be repeated?

Repeat treatment may be considered where the first injection has provided worthwhile relief, and there is a clear clinical reason to use it again.

Dr Jones will review the response, the time since treatment and any changes in symptoms before recommending a further injection.

A repeat injection should not simply be given automatically when pain returns.

Are there any risks?

Most patients tolerate these injections well, but temporary discomfort, stiffness or swelling can occur after treatment.

Less common risks include bleeding, infection, an inflammatory reaction or an allergic response.

Cingal also carries the considerations associated with corticosteroid treatment. This may include a temporary rise in blood glucose in patients with diabetes.

The benefits and risks will be discussed before consent is taken.

A treatment plan, not simply an injection

Cingal and Monovisc are not usually used as stand-alone treatments.

The aim is often to reduce symptoms enough to allow better movement, strengthening and participation in rehabilitation.

The wider plan may include:

• Physiotherapy and progressive strengthening
• Changes to exercise or training load
• Weight management where relevant
• Bracing or support
• Footwear advice
• Medication
• Further imaging or referral where needed

Dr Jones will explain where the injection fits and what should happen before and after treatment.

Is Cingal or Monovisc right for me?

The most important question is not simply which injection is available, but whether an injection is appropriate for the type of pain you are experiencing.

Before recommending treatment, Dr Jones will assess the knee, review any scans or previous treatment and discuss the expected benefits, limitations and alternatives.

The final decision will be made with you, based on your symptoms and goals.