We use a Durolane injection to treat a common cause of arthritis, osteoarthritis. This condition affects the hips, knees, shoulders, thumbs, and other joints. Generally, the treatment of osteoarthritis consists of modifying lifestyle factors, such as exercise and weight loss, combined with medications, including oral or injectable agents. Some treatments for osteoarthritis are more effective than others. So, how useful is a Durolane gel injection UK for osteoarthritis, and what are other frequently asked questions about this injection?  

What is Durolane?  

Durolane injection

Durolane is a hyaluronic acid-based product. Sodium hyaluronate, naturally found in the lining of joints, acts as a shock absorber or lubricant. Generally, arthritic joints have less hyaluronic acid, which reduces shock absorption and cushioning.  

We make Durolane synthetically through bacteria. We modify the shape of hyaluronic acid molecules to improve their performance.  

How Does a Durolane Gel Injection Work? 

When injected into joints, Durolane has several actions. First, it acts as a lubricant, cushioning joints from further damage. Second, it binds to receptors in the joints to reduce toxic substances that further degrade cartilage.

We adjust the size and consistency of Durolane to improve its performance. Increasing the molecular weight makes the effect more potent. Also, linking molecules together means they are not broken down by the body as quickly, leading to a longer-lasting impact.

What is a Durolane Injection used for?  

X-ray showing no cartilage in knee - can osteoarthritis be reversed

Generally, we use Durolane gel injection for knee arthritis when simple treatments such as exercise and weight loss are not enough. We also use it for other joints, such as the hip, shoulder, and ankle. 

Sometimes, doctors use hyaluronic acid for tendonitis, such as tennis elbow or Achilles tendonitis. However, we generally don’t use Durolane, as it’s too strong for tendons.  

How Effective is a Durolane injection compared to other Treatments? 

A recent study looked at the effectiveness of treatments for knee arthritis. Overall, hyaluronic acid injections were the most effective and equal to PRP injections. However, when hyaluronic acid is separated  into high and low-molecular-weight fractions, the high-molecular-weight fraction, e.g.,s Durolane) is more effective. By contrast, lower-molecular-weight hyaluronic acids, such as Ostenil plus, are less effective. 

Specifically, regarding Durolane, a study of more than 700 injections into the knee or hip joints over six years found that 70% of participants were satisfied. Additionally, the effect lasted for more than 400 days on average.

Comparing Injectables, Durolane, PRP or Arthrosamid: Which Drug is more Effective?

According to studies published on each treatment for knee arthritis, we think the effectiveness of the treatment of knee arthritis in percentage terms is as follows:

Durolane: 70%

PRP: 60-75%

Arthrosamid 75% (although long-term data for Arthrosamid is lacking). 

Administration of Durolane Gel Injection 

Doctors administer Durolane injections into joints.    

In general, we recommend that injections be performed with imaging guidance. Ultrasound is a much cheaper way of guiding injections than other methods, such as X-ray or fluoroscopy. Moreover, a recent study shows that hyaluronic acid injection under ultrasound guidance has a significantly greater effect than injection without ultrasound.

Administering a Durolane injection will take less than 30 minutes. First, your doctor will clean the skin with an antiseptic and use sterile gloves and dressing packs. Next, you will be given local anaesthesia, and the injection will be administered to reduce discomfort. Then, using ultrasound, we inject Durolane into the knee joint. The injection should not be too painful if your doctor uses an ultrasound.

Recovery after Durolane Injection 

Generally, we recommend you rest your joint for about a week. After a week, you can start non-impact activities such as swimming and cycling. After 10 days, it is safe to resume running.

However, if you experience joint flare, you should rest the joint until your symptoms subside.

How Long Does it take for Durolane Injections to Work? 

Generally, Durolane’s effect starts within four weeks of an injection. However, some studies suggest the pain-relieving effect begins at two weeks. 

Sometimes, it may take up to six weeks to observe an effect after a Durolane gel injection.

How Long Do Durolane Injections Last? 

Overall, Durolane gel injections last longer than other injections, such as cortisone. For example, in a recent study, a single Durolane injection for knee or hip arthritis lasted, on average, over 400 days. However, some people will have a more prolonged effect, whereas others will have a shorter one.

In addition, Durolane’s effect is better in younger patients with milder forms of osteoarthritis. However, even elderly patients with severe arthritis can benefit.

If a Durolane Gel Injection Is Effective, Can I Have a Repeat Injection?

We recommend a repeat injection no earlier than 6 months after your last injection. Studies indicate repeat injections are just as effective as the first injection for up to five repeat injections. 

Durolane Injection Side Effects  

Like any injection, Durolane is not without side effects and risks. However, adverse effects were not increased compared to other injections. Most side effects are mild and resolve without medical attention. Overall, adverse effects include:

Common side effects  

Some of the more common side effects of Durolane include:

  • Mild joint swelling lasting for up to a few weeks (10-20%)
  • Joint pain, which settles after about a week
  • Muscle stiffness around a joint

Rare but severe side effects

See a doctor if you suffer from any of the following side effects:

  • Severe joint swelling suggests an allergic reaction. Often, a doctor must drain the knee and test it to rule out infection. This reaction occurs rarely (1:100). We also hypothesise that the reaction rate is lower when the injection is performed using ultrasound.  
  • Severe swelling, pain, and intense heat or warmth from the joint suggest an infection. You may also experience generalised aching, fever, and sweating (1:10000). 

I‘ve heard reports of severe pain after a Durolane gel injection. Are these reports accurate? 

Yes. There have been case reports of severe reactions after Durolane injections. Mild reactions are reasonably common (10-20%) and last 1-2 weeks. However, some patients experience severe reactions (1:100), and the reasons for these reactions remain unclear. A recent study suggests a severe reaction can arise with any hyaluronic acid, not just Durolane. Additionally, these reactions are more frequent when hyaluronic acid is accidentally injected outside the joint.

Other Frequently Asked Questions about Durolane: 

Is Durolane a steroid?

No. Durolane is a hyaluronic acid, a naturally occurring substance in joints and tendons. A steroid is a chemical that mimics cortisol, which is produced by the adrenal glands. 

Does the molecular weight of hyaluronic acid matter? 

Generally, molecular weight refers to the mass of hyaluronic acid molecules. Viscosupplementation can be high- or low-molecular-weight. High molecular weight only needs one injection.

Recent evidence suggests that high-molecular-weight hyaluronic acid is better. In one study, the effect of high-molecular-weight hyaluronic acid was at least double that of low-molecular-weight hyaluronic acid. In addition, the Arthroscopy Association of Canada suggests that high-molecular-weight hyaluronic acid has a better impact on knee and hip arthritis. 

Durolane injection UK vs Synvisc: which is better?

Both Durolane and Synvisc are high-molecular-weight hyaluronic acids. However, Synvisc is made from egg protein, which increases the risk of allergic reactions. 

Additionally, a recent study compared these two brands for the treatment of knee arthritis. The study found that only Durolane had a better effect than Synvisc at six months post-injection. 

Durolane injection UK vs PRP (platelet-rich plasma): which is better? 

There have been no comparisons between these two injections. However, a recent study found that a high-molecular-weight hyaluronic acid, such as Durolane, had the same effect as PRP. This positive effect is more consistent with Durolane but is more variable in PRP. In addition, Durolane requires a single injection, whereas PRP may require up to three injections. A second-generation PRP, ACP Max, means that you only need one PRP injeciton now. 

Can you have Durolane injection UK together with PRP? 

Yes. Recent evidence suggests that combining hyaluronic acid with PRP is superior to either alone. Compared to PRP alone, combining the two improves outcomes at 3, 6, and 12 months.

Is an ultrasound-guided Durolane injection better? 

Yes. Using ultrasound guidance means that the injeciton is more accurate and effective.

A recent study showed that hyaluronic acid injections performed under ultrasound guidance have a significantly better effect than blind injections (without ultrasound). We also think using ultrasound reduces the risk of a severe allergic reaction. 

You should ensure your doctor uses an ultrasound to administer a knee gel injection. 

Can you walk after a Durolane injection? 

Yes, but you should limit your walking for a few days after a Durolane injection. We recommend avoiding sports for at least a week after the activity. This blog outlines the post-injection activity after a knee gel injection. 

How many Durolane injections are permitted? 

Unlike cortisone, Duroalne is not harmful to joints. There is evidence that Durolane may protect knee joints. One study found that regular use of Durolane for knee arthritis delayed the need for knee replacement. 

The number of Duroalne injections is unlimited. However, the time between injections should be at least six months. 

Final word from  sportdoctorlondon about Durolane injection UK

Durolane is a hyaluronic acid-based product that is effective for osteoarthritis. Generally, it is our preferred first injection option for knee arthritis unless you’ve had a reaction to Durolane in the past.

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