We use Durolane injection to treat a common cause of arthritis called osteoarthritis. This condition affects the hips, knees, shoulder, thumb, and other joints. Generally, the initial 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 injection UK for osteoarthritis, and what are other frequently asked questions about this injection?

What is Durolane?  

Durolane injection

Durolane is a purified 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 sodium hyaluronate, meaning they provide less shock absorption or cushioning than normal joints.

We make Durolane synthetically through fermented bacteria. In addition, we change the shape and consistency of the hyaluronic acid molecules to make them work more effectively.

How does a Durolane injection work? 

Generally, we think Durolane has several actions when injected into joints. First, it acts as a lubricant, cushioning joints from further damage. Second, it binds to receptors in the joints to lower toxic substances that break down cartilage further.

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

What is a Durolane injection used for? 

X-ray showing no cartilage in knee

Generally, practitioners use Durolane for knee arthritis that has not responded to simple treatments such as exercise, weight loss, and medications. Also, we use it for other joints, such as the hip, shoulder, and ankle, although the evidence for effectiveness in these joitns is less.

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

How effective is a Durolane injection compared to other treatments? 

A recent study looked at the effectiveness of non-surgical 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 or Synvisc are less effective.

Specifically, about Durolane, a study of over 700 injections into the knee or hip joints over six years found that 75% of people were satisfied. Also, on average, the injections effect lasted for over 400 days.

Administration 

Doctors administer Durolane injections into joints.

In general, we recommend injections are done with imaging to improve accuracy. Ultrasound is a much cheaper way of guiding injections than other methods such as X-ray or fluoroscopy. Before having an ultrasound-guided injection, you should ask the following four questions to your practitioner. Moreover, a recent study shows that a hyaluronic acid injection performed with ultrasound has a much better effect than blind injections (without ultrasound). In a survey with over 1000 patients who had hyaluronic acid injections for knee arthritis, ultrasound injections had much fewer rates of knee replacement (over 30% less) than those who had blind injections. Moreover, ultrasound-guided hyaluronic acid injections were 27% less likely to need a subsequent cortisone injection for pain.

Administering Durolane injection will take less than 30 minutes. First, your doctor will clean the skin with 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 painful if your doctor uses ultrasound.

After the injection, your doctor will ask you to rest the knee and apply ice. It would be best if you did not drive home. Generally, resting the knee from excessive activity, such as longer walks for at least three days, would be best. You can resume impact activity and sport after five days if you don’t experience side effects.

How long do Durolane injections take to work? 

Generally, the effect of Durolane starts within four weeks of an injection. However, some studies suggest an impact occurs as early as two weeks. 

How long does Durolane last? 

man holding hand due to knee clicking

Overall, Durolane 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, for over 400 days. But, of course, some people will have a more prolonged effect, whereas others will have a shorter effect.

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

If a Durolane injection works, can I have a repeat injection, and is it as effective?  

We suggest a repeat injection no sooner than six months from your last injection. Studies indicate those 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, compared to ‘placebo’ injections (using sterile water), there were no increased adverse effects. 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
  • Joint pain, which settles after about a week
  • Muscle stiffness around 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, sometimes called ‘pseudosepsis’. Often, a doctor must drain the knee and test it to rule out infection. This particular reaction rarely occurs. We also think the reaction rate is less if done with image guidance using ultrasound.
  • Severe swelling, pain, and intense heat or warmth from the joint suggest an infection. Also, you may feel unwell with generalised aching, fevers, and sweats. This reaction is about 1-10000 to 1-100000.

Other hyaluronic acid injections 

Several other hyaluronic acid injections are on the market. These brands include Ostenil, Synvisc, and Supatz. They vary in molecular weight and viscosity, so they are generally different from Durolane.

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.

There is some debate about whether high or low molecular weight is better. However, recent evidence suggests that high molecular weight hyaluronic acid is better. In one study, the effect of high molecular weight was at least double the low molecular weight. In addition, the Arthroscopy Association of Canada suggests that high molecular weight hyaluronic acid demonstrates a better effect on knee and hip arthritis pain.

Also, low molecular weight hyaluronic acid needs more than one injection (often up to five). For example, a study comparing one injection of Durolane with five injections of a low molecular weight hyaluronic acid showed no difference in effect.

Durolane injection UK vs. Synvisc 

Both Durolane and Synvisc are high molecular weight hyaluronic acids. However, Synvisc is made from egg protein. We think that egg protein increases the risk of adverse reactions such as allergies.

Also, a recent study examined a head-to-head comparison of these two brands for the treatment of knee arthritis. The scientists found that only Durolane had a positive effect on pain six months after the injection, whereas Synvisc only had an impact at three months but not six months.

Durolane injection UK vs PRP (platelet-rich plasma)

There have been no head-to-head 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. Also, this positive effect seems more consistent with Durolane but is much more variable in PRP. In addition, Durolane is only one injection, whereas PRP requires up to three injections.

Can you have Durolane injection UK together with PRP? 

Yes. Recent evidence suggests combining hyaluronic acid with a PRP is better than either alone. Combining two improves outcomes at 3, 6, and 12 months compared to PRP alone.

Final word from Sportdoctorlondon about Durolane injection UK

Durolane is one injection of hyaluronic acid that is effective for joint arthritis. Generally, it is our preferred injection option unless you’ve had a reaction to Durolane in the past.

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