Durolane Injection: A Complete UK Guide

We use a Durolane injection to treat osteoarthritis — the most common form of arthritis. The condition affects the knees, hips, shoulders, thumbs, and other joints. Treatment starts with exercise, weight loss, and medication. When these are not enough, injections come next. Durolane is our preferred first-choice injection for knee arthritis and requires only one dose. Dr Masci performs a Durolane gel injection under ultrasound guidance at his London clinics as a one-stop visit. This guide explains how Durolane works, the evidence, the cost in the UK, and the most common questions patients ask.  

What is Durolane?

Durolane injection

Durolane is a hyaluronic acid product. Hyaluronic acid occurs naturally in the lining of joints, where it acts as a shock absorber and lubricant. Arthritic joints contain less of it, so they lose cushioning.

Manufacturers produce Durolane synthetically using bacteria. They modify the shape of the hyaluronic acid molecules to boost performance. Linking the molecules together (cross-linking) stops the body breaking them down quickly — which gives Durolane its long-lasting effect.

How does a Durolane gel injection work? 

Inside the joint, Durolane acts in two ways. First, it lubricates and cushions the joint against further damage. Second, it binds to receptors in the joint and reduces the toxic substances that degrade cartilage. Higher molecular weight makes the effect more potent, and Durolane sits at the high end of the molecular-weight range.

What do we use a Durolane injection for?

We mainly use Durolane for knee arthritis when exercise and weight loss are not enough. We also inject it into the hip, shoulder, and ankle. In fact, Durolane is Dr Masci’s preferred injection for shoulder osteoarthritis, where he finds it outperforms options such as PRP.

Doctors sometimes use hyaluronic acid for tendonitis, such as tennis elbow or Achilles tendinopathy. We avoid Durolane for tendons — it is too strong.

How effective is a Durolane injection?

The evidence supports it. A study of treatments for knee arthritis found hyaluronic acid injections to be among the most effective options, comparable to PRP. When researchers separated high- and low-molecular-weight products, high-molecular-weight products such as Durolane performed better. Lower-weight products, such as Ostenil Plus, performed worse.

For Durolane specifically, a study of more than 700 knee and hip injections over six years found 70% of patients were satisfied. The effect lasted more than 400 days on average, over a year from a single injection.

Durolane vs PRP vs Arthrosamid: which works best?

Based on the published studies for knee arthritis, we estimate effectiveness as follows: Durolane around 70%, PRP around 60–75%, and Arthrosamid around 75% (with less long-term data). Durolane offers the most consistent effect for the lowest cost, which is why we use it first for most knees. Where Durolane has worked but worn off, or where it has failed, we then consider ACP Max PRP or Arthrosamid.

How does Dr Masci perform a Durolane injection?

Dr Masci performs every Durolane injection under ultrasound guidance. Ultrasound costs far less than X-ray or fluoroscopy guidance, and a recent study shows hyaluronic acid injections work significantly better under ultrasound than blind injections. We also think ultrasound lowers the risk of a severe reaction, because reactions occur more often when the gel lands outside the joint.

The appointment takes less than 30 minutes. Dr Masci cleans the skin with an antiseptic and uses a sterile technique. He numbs the area with a local anaesthetic. He then guides the needle into the joint under ultrasound and injects the gel. With ultrasound, the injection causes little pain. 

Dr Masci has performed thousands of ultrasound-guided injections and teaches these techniques to doctors across the UK and Europe. Read about his injection expertise here.

How much does a Durolane injection cost in the UK?

Durolane injection prices in London vary widely — typically £400 to £800, and sometimes more. Dr Masci offers an ultrasound-guided Durolane injection at his Chelsea clinic for £490. Prices apply to the Chelsea clinic; other clinic locations cost more. See our one-stop injection fees and clinic locations.

Because one Durolane injection lasts an average of over 400 days, the cost per month of relief compares well with other injectables.

Recovery after a Durolane injection

Rest the joint for about a week. After a week, start non-impact activities such as swimming and cycling. After 10 days, you can resume running. If the joint flares, rest until the symptoms settle.

For athletes, Dr Masci recommends: offload for 3 days; if no flare, non-impact activity for 4 more days; running after a week; and sport-specific training from 10 days if the joint stays quiet.

How long does Durolane take to work?

The effect usually starts within four weeks, though some studies report pain relief as early as two weeks. In some patients, it takes up to six weeks. Do not judge the injection too early.

How long does a Durolane injection last?

Longer than most injections. In a recent study, a single Durolane injection for knee or hip arthritis lasted an average of over 400 days. Younger patients with milder arthritis respond best, but even elderly patients with severe arthritis can benefit.

Can I have a repeat Durolane injection?

Yes. Leave at least 6 months between injections. Studies show that repeat injections work as well as the first injection, for up to five repeats. From the sixth injection onwards, effectiveness drops slightly but still averages around 200 days of relief. There is no upper limit on the number of injections — unlike cortisone, Durolane does not harm joints, and one study found regular Durolane use delayed the need for knee replacement.

Durolane injection side effects

Most side effects are mild and settle without treatment. Side-effect rates match other injectables.

Common side effects

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

Rare but severe side effects

See a doctor if you develop either of the following. Severe joint swelling suggests an allergic-type reaction (around 1 in 100); a doctor may need to drain and test the knee to exclude infection. Severe swelling with intense heat, fever, sweating, and generalised aching suggests infection (around 1 in 10,000).

We believe ultrasound guidance lowers the reaction rate, because severe reactions happen more often when hyaluronic acid lands outside the joint. Reactions can occur with any hyaluronic acid brand, not just Durolane.

Frequently asked questions about Durolane injections.

Is Durolane a steroid?

No. Durolane is a hyaluronic acid — a substance that occurs naturally in joints and tendons. A steroid mimics cortisol from the adrenal glands. The two work completely differently.

How soon after a cortisone injection can I have Durolane?

Dr Masci generally performs a Durolane injection at least 6 weeks after a cortisone injection.

Does the molecular weight of hyaluronic acid matter?

Yes. High-molecular-weight hyaluronic acid needs only one injection and works better. One study found its effect at least double that of low-molecular-weight products. The Arthroscopy Association of Canada also recommends high-molecular-weight hyaluronic acid for knee and hip arthritis.

Durolane vs Synvisc: which is better?

Both are high-molecular-weight hyaluronic acids. However, Synvisc is made from egg protein, which raises the risk of allergic reactions. A recent comparison study in knee arthritis also favoured Durolane at six months post-injection.

Durolane vs PRP: which is better?

No head-to-head trial exists. However, a recent study found that high-molecular-weight hyaluronic acid matched PRP overall. Durolane delivers its effect more consistently, while PRP results vary more between patients. Durolane also requires a single injection, whereas standard PRP may require up to three, though ACP Max, a second-generation PRP, now delivers PRP in a single injection as well.

Can you combine Durolane with PRP?

Yes. Recent evidence suggests combining hyaluronic acid with PRP beats either alone, improving outcomes at 3, 6, and 12 months.

Is an ultrasound-guided Durolane injection better?

Yes. Ultrasound makes the injection more accurate and more effective, and we think it reduces the risk of severe reactions. Always check that your doctor uses an ultrasound for a knee gel injection.

Can you walk after a Durolane injection?

Yes, but limit your walking for a few days. Avoid sports for at least a week. This blog covers post-injection care in detail.

Does Durolane work for bone-on-bone arthritis?

Yes, we use it for established knee osteoarthritis, including bone-on-bone changes. Results are better in mild-to-moderate arthritis, but patients with severe arthritis — even those awaiting knee replacement — can still benefit.

What if Durolane doesn’t work for me?

No injection works for everyone. Durolane helps about 70% of patients with knee arthritis, so roughly 3 in 10 see no benefit. If Durolane fails, options include ACP Max PRP, Arthrosamid, or a structured plan covered in our knee injection guide.

Final word from Sport Doctor London about Durolane injection UK

Durolane is an effective, long-lasting hyaluronic acid injection for osteoarthritis. One ultrasound-guided injection provides over a year of relief for most patients, and repeat injections continue to work. It remains our preferred first injection for knee arthritis, unless you have reacted to Durolane before.

To book a one-stop Durolane gel injection in London, contact Dr Masci’s team here or call +44 (0) 203 488 0350.

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