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

What is Durolane?  

Durolane injection

Durolane is a form of hyaluronic acid. Sodium hyaluronate, naturally found in the lining of joints, acts as a shock absorber or lubricant. Generally, arthritic joints have less hyaluronic acid, meaning they provide less shock absorption or cushioning.  

We make Durolane synthetically through bacteria. We change the shape of the hyaluronic acid molecules to make them work better. 

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 lower toxic substances that further break down cartilage.

We alter the size and consistency of Durolane to make it work better. Increasing the size to make it high molecular weight means the effect is more potent. Also, linking the molecules together means that the molecules are not broken down by the body as fast, leading to a longer-lasting impact.

What is a Durolane injection used for?  

X-ray showing no cartilage in knee

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. But generally, we 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, if we separate hyaluronic acid into high and low molecular weight, the high molecular weight hyaluronic acid (such as Durolane) is much more effective. On the contrary, lower molecular weight hyaluronic acids such as Ostenil are less effective. 

Specifically, about Durolane, a study of over 700 injections into the knee or hip joints over six years found that 70% of people were satisfied. Also, on average, the effect lasted for over 400 days.

Comparing injectables, Durolane, PRP or Arthrosamid: Which drug is more effective?

According to studies published on each treatment in 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 done with imaging. Ultrasound is a much cheaper way of guiding injections than other methods such as X-ray or fluoroscopy. Moreover, a recent study shows that a hyaluronic acid injection performed with ultrasound has a much better effect than injections 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 anaesthesia into the skin, where the injection will be administered to help reduce discomfort. Then, using ultrasound, we inject Durolane into the knee joint. The injection should not be too painful if your doctor uses 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. Then, after ten days, it is safe to return to running.

However, if you develop a joint flare, you should rest your joint until your symptoms settle.

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 might take up to six weeks to notice an effect from a Durolane gel injection.

How long do Durolane injections last? 

man holding hand due to knee clicking

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. But, of course, some people will have a more prolonged effect, whereas others will have a shorter.

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 works, can I have a repeat injection?

We suggest a repeat injection no earlier than six months from 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. Generally, most side effects are mild and will go away without the need for 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 particular reaction rarely occurs (1:100). We also think the reaction rate is lower if the injection is done with an ultrasound.  
  • Severe swelling, pain, and intense heat or warmth from the joint suggest an infection. You may also feel unwell with generalised aching, fevers, and sweats (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 have severe reactions (1:100), and we don’t know why they occur. A recent study suggests a severe reaction can arise with any hyaluronic acid, not just Durolane. Also, these reactions occur more frequently if a hyaluronic acid injection 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 mimicking cortisol produced by adrenal glands in the body. 

Does the molecular weight of hyaluronic acid matter? 

Generally, molecular weight refers to how heavy the hyaluronic acid molecules are. Viscosupplementation can be high molecular 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. 

Also, a recent study compared these two brands for treating 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 only one injection, whereas PRP requires up to three injections.

Can you have Durolane injection UK together with PRP? 

Yes. Recent evidence suggests that combining hyaluronic acid with PRP is better than either. Compared to PRP alone, combining 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 with ultrasound have a much 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 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 suggest you avoid sports for at least a week after the activity. This blog guides activity after a knee gel injection. 

How many Durolane injections can you have? 

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