Durolane Injections: Effective? Cost? Worth it?

Durolane – Treatment Potency Rating (TPR)

We have developed a bespoke treatment scoring system called Treatment Potency Rating (TPR) which allows you to preview how efficacious each treatment is, at a glance.

This is our Treatment Potency Rating (TPR) of Durolane in a table format:

Durolane Rating:	7.2 / 10.0
How it works? (Mechanism of Action, MoA):	Supplements the synovial joint fluid.
What proof is there? (Evidence For Efficacy):	Clinical trials and anecdotal reports.
Date to market? (Longitudinal Data):	Since 2001.
Risks? (Side Effect Profile):	In most cases, minimal. Mild redness.
Treatment Duration:	1 injection. Can repeat, if needed.
Recovery Time:	Minimal. A day, or less than a week.
Cost-effectiveness:	More expensive than other brands.
Provider Expertise:	Moderate expertise is required.
Best Suited For:	Osteoarthritis (OA).

Durolane – Treatment For Osteoarthritis

Durolane is a brand name for an injection-based, osteoarthritis (OA) treatment.

Durolane is not a steroid. It’s made from non-animal stabilised hyaluronic acid (also known as NASHA) obtained via bacterial fermentation.

This hyaluronic acid is then purified and stabilised using covalent bonds and ‘natural entanglement’ (1).

Natural entanglement refers to the way hyaluronic acid (HA) molecules intertwine and link together without synthetic modifications – ensuring greater bio-compatibility.

Meaning, Durolane is more compatible with the human body and there’s a reduced risk of adverse reactions.

Also, Durolane is usually administered as a single injection, unlike other similar treatments which require multiple.

What is hyaluronic acid and why do we inject it?

Well, hyaluronic acid is naturally found inside each joint. It functions as a cushion and lubricant.

However, in joints affected by arthritis, the amount of HA decreases over time.

This results in suboptimal shock absorption and less effective cushioning, contributing to the typical pain and stiffness associated with OA.

For this reason, by injecting Durolane into the joint, we effectively supplement and replenish the natural hyaluronic acid. This is often referred to as viscosupplementation.

This results in long-lasting pain relief, reduction in joint stiffness and increased mobility.

However, it’s advisable not to rush your treatment with Durolane. There are other similar brands which offer hyaluronic acid injections. And some offer different versions of HA which may be more befitting for your particular condition.

To learn more about these different options, check the Alternatives section by (clicking here).

Durolane Injections vs Cortisone

Hyaluronic acid injections (such as Durolane) offer a natural arthritis remedy by replenishing the hyaluronic acid levels of the affected joint.

Corticosteroid injections (such as Cortisone), on the other hand, are synthetic corticosteroids. They are designed to mimic the anti-inflammatory effects of the hormone cortisol, which is produced by the adrenal glands.

Therefore, both treatments have very different mechanisms of action (MoA).

Hyaluronic acid injections:

• They act as a lubricant and shock absorber within the joints.

• And while the benefits of hyaluronic acid injections take longer to manifest, often up to 4 weeks they also tend to provide longer-lasting relief than cortisone.

• On average, for hyaluronic acid injections, you can expect effects lasting 6 to 12 months. But in the case of high molecular weight hyaluronic acid treatments like Durolane, up to 15 months.

Corticosteroid injections:

• They are particularly effective for acute reduction in pain, swelling, and inflammation.

• Administered under ultrasound guidance, cortisone injections provide significant relief within 1-7 days, with effects lasting up to 3 months.

• However, their effectiveness may diminish after three months. Also, repeated Cortisone injections can lead to more rapid cartilage degradation and a potential need for earlier joint replacement surgeries. Therefore, cortisone use is recommended to be limited to severe cases of pain and swelling.

Some clinics offer a combined Durolane + Corticosteroid injection. Since they can work together as synergists and enhance the overall treatment effect.

The corticosteroid component quickly reduces inflammation and pain, offering rapid relief. While Durolane provides longer-term improvement in joint lubrication and cushioning. This dual approach targets both the symptoms and underlying causes of osteoarthritis, aiming to reduce immediate pain and improve joint function over time.

Clinical data showcases repeated co-injections of corticosteroids plus HA more effectively decreased pain and improved physical function than injections of HA alone (2).

Durolane Injections for Knee Pain

The knee is the largest joint in the body. It bears a significant portion of your weight while providing essential mobility.

This means it is often subject to more wear and tear than other joints, making it especially prone to osteoarthritis.

Durolane injections are particularly effective for knee pain due to several reasons.

Firstly, just like with any other joint, Durolane supplements the synovial fluid of the knee and its viscoelastic properties.

Clinical evidence demonstrates that Durolane injections, which utilise non-animal stabilised hyaluronic acid (NASHA), provide effective and sustained relief of knee osteoarthritis symptoms.

We analysed a systematic review investigating the efficacy and safety of Durolane in patients with knee osteoarthritis.

The findings showcase that treatment with Durolane (NASHA) is associated with significant improvements in pain and function. There was also a low rate of adverse events, highlighting Durolane’s safety and effectiveness as an intra-articular therapy for osteoarthritis​ (Durolane injections, 3)

Secondly, since the knee joint is the largest, it also has a large synovial cavity (the space between the articulating surfaces of the joint).

This allows for a more effective distribution of the injected hyaluronic acid compared to smaller joints.

Plus, this bigger synovial cavity allows for the use of higher molecular weight hyaluronic acid injections (like Durolane), compared to smaller joints.

Durolane, specifically, has a very high molecular weight of 10¹⁵ kDa compared to other similar brands.

And in general, the higher the molecular weight the more viscous the hyaluronic acid. This increased viscosity is due to the longer chains of the hyaluronic acid molecules, which create a thicker, gel-like substance.

For these reasons, the knee joint is a great candidate for Durolane injections.

Durolane Injections – Price

In the UK, Durolane injection prices can range from £300 – £500+ per injection.

This range can vary depending on the clinic, location, and any additional medical services that might be required alongside the injection.

For example, a Durolane + Corticosteroid injection will be slightly more expensive than just Durolane alone, but it will also be more effective in most cases.

It’s always advisable to choose a clinic or a specialist who has a lot of experience with intra-articular injections, i.e. joint injections.

Preferably someone who does Ultrasound-guided Durolane injections, which ensures accuracy in delivering the hyaluronic acid directly into the affected joint space.

And are Durolane Injections available on the NHS?

Unfortunately, rarely.

As per the NHS commissioning decision:

“Hyaluronic Acid injections (Durolane and others included) are considered a low priority for funding and will only be considered in exceptional circumstances. Funding approval must be sought from the local integrated care board (ICB) via the Individual Funding Request process prior to treatment.” (NHS Decision)

This specific statement is taken from an NHS Gloucestershire document but is effectively the same for the entirety of the UK.

If you fall within these “exceptional circumstances” and manage to get Durolane via the NHS, great.

But if you wish not to waste time, it’s best to seek private treatment.

Durolane Injections – Patient Reviews

What do people who’ve had Durolane say? And what is the overall success rate of Durolane injections?

Let’s break down the patient data into two groups – empirical (scientific) and anecdotal (word of mouth).

Empirical:

We examined all the clinical literature on the matter. And here we’ll go over the most befitting data.

First, let’s see how long a Durolane injection lasts exactly.

This 6-year-long study (4) measured the repeated use of Durolane Injections in 623 osteoarthritis patients.

The outcome was sustained pain relief for 466.8 days or 1.3 years (on average) post initial treatment with Durolane. Which means just a single injection provided 1.3 years of pain relief.

Additionally, patients who received subsequent injections reported even further prolonged benefits.

A different study (5) aggregated the evidence for Durolane’s efficacy in the context of knee osteoarthritis.

The results, yet again, demonstrated sustained and effective relief of knee OA symptoms following just a single Durolane injection.

Moreover, Durolane showed an excellent bio-compatibility profile.

Meaning – it works well with the body’s joints and surrounding tissues without causing harm or unwanted reactions. For this reason, the study depicted Durolane as a safe single-injection procedure for the treatment of knee osteoarthritis.

Anecdotal:

As for anecdotal (word of mouth) patient reviews, there are hundreds online.

We meticulously examined all the reviews, specifically looking for repeating mentions – which would indicate higher statistical significance, albeit the data being anecdotal.

The overall reviews are mixed. Patients either praise Durolane, or don’t like it (Patient Reviews)

We found a matching overtone between patients who have complained. Some blame Durolane for its inefficacy, but most likely the physician who administered the injection did a poor job.

Whereas the patients who’ve had amazing results with Durolane, went to a qualified clinic or practice where it was injected with guided ultra-sound in a sterile environment.

So our consensus is that Durolane is indeed effective, however, it must be administered by an experienced injection specialist.

Otherwise, complications may occur or Durolane might not work as intended.

For these reasons, you must ensure to only work with qualified professionals who have sufficient experience with intra-articular (joint) injections.

What to Expect During The Procedure? Any Pain?

The Durolane injection procedure is quite straightforward and minimally invasive.

In most cases, the doctor or injection specialist will first apply a local anaesthetic to completely numb the area.

Then they will use ultrasound to accurately guide and inject Durolane into the affected joint.

This ensures the high molecular weight hyaluronic acid goes exactly where it’s needed most.

The whole appointment should be approximately 1 hour (or less), including the initial consultation.

And patients typically experience minimal or no discomfort at all, during the procedure itself.

The recovery after a Durolane injection is also generally quick. Most patients can resume their normal activities within a few days.

After the injection, some may notice immediate relief, while for others, the reduction in pain and improvement in joint function may develop over the following weeks.

Some individuals may experience mild soreness, swelling, or bruising at the injection site, depending on the proficiency of the injection specialist.

But typically this resolves within a few days to a week.

It’s recommended to avoid strenuous activities or high-impact sports for at least 48 hours after the injection to allow the joint to settle.

What Are The Side Effects of Durolane?

Durolane was introduced to the market in 2001 by TRB Bioventus.

Since then it has amassed plenty of clinical and anecdotal longitudinal data regarding its safety and efficacy.

Thousands of people have had Durolane injected in joints commonly affected by Osteoarthritis.

And most haven’t had any serious adverse side effects.

However, like with any other medical procedure, there are potential side effects and risks.

We’ll list the side effects below. And in the next few sections, we’ll discuss how to minimise or eliminate them entirely.

These side effects can happen with any hyaluronic acid injection, not just Durolane. And are primarily dependent on the skillfulness of the injection specialist or doctor:

Common MILD side effects (10-20% of patients):

• Pain at the injection site: Some patients may experience temporary discomfort or mild pain where the injection was administered. This shouldn’t last more than 1 week.
• Swelling and redness: Minor swelling or erythema (redness) around the injection area can occur. This typically resolves on its own within a week.
• Joint and muscle stiffness: A temporary increase in stiffness at the target joint, or the muscles around it. You might notice this immediately after the procedure but it should subside within 1-2 weeks.

Rare SEVERE side effects (≤1% of patients):

• Allergic reaction: In very rare cases, patients may have an allergic reaction to the components of the HA injection. This can involve symptoms such as swelling, redness, and itching at the injection site.
• Pseudosepsis: Which combines “Pseudo” + “sepsis” = it mimics the symptoms of sepsis. Such as fever, increased heart rate, and increased white blood cell count, but does not involve a bacterial infection or actual sepsis.

Both allergic reactions and pseudosepsis are very uncommon.

Hyaluronic acid is naturally found in our joints, skin, eyes and connective tissue. It has high bio-compatibility. Therefore, when injected into the problem area, the body easily recognises and accepts it.

Extremely Rare SEVERE side effects (≤0.1% of patients):

• Infection: Like with any other injection, a needle must penetrate the skin to deliver the active ingredients. And this always carries a tiny risk of an infection. If you notice severe swelling, pain, intense warmth arising from the joint and/or fever, contact your doctor immediately.

Infections are extremely uncommon. They are much more dependent on the doctor’s clinical competence and sanitary practices than anything else.

Therefore Durolane is considered generally very safe.

But it’s important to note that Durolane has not been tested in pregnant or lactating women or children.

How to Prevent Side Effects?

To prevent or minimise the risk of side effects from Durolane or any other hyaluronic acid injection, consider the following:

• Ultrasound Guidance: Ensure your doctor is using ultrasound to guide the injection. As this study demonstrated (6) patients receiving ultrasound-guided knee hyaluronic acid injections were significantly less likely to undergo subsequent knee complications than patients receiving landmark-guided (physical touch, no imaging) hyaluronic acid injections.
• Combined Therapy: Theoretically, combining Hyaluronic Acid with a Corticosteroid (such as Cortisone) may reduce the risk of an acute inflammatory reaction or pseudosepsis. Corticosteroids block pro-inflammatory mediators, suppress the production of cytokines, and prevent factor NF-κB from activating, all of which decrease inflammatory gene expression (7). Therefore, in theory, corticosteroids can reduce the risk of acute inflammation or pseudosepsis. And even augment the positive effects of HA. However, corticosteroids themselves can have side effects. This includes potentially impacting blood sugar levels and the tissues around the injection site. So you and your doctor should carefully consider the pros and cons of combined HA + Corticosteroid therapy.
• Treatment Quality: Ensure the Hyaluronic Acid brand your doctor uses is of high quality and sourced from reputable manufacturers, such as Durolane. Be aware of the product’s composition, as certain additives or preservatives (excipients) might increase the risk of an adverse reaction.

The full ingredients list of Durolane is:

• Stabilised Hyaluronic Acid (fermentation via a proprietary bacteria strain, NASHA)
• Sodium Chloride
• Potassium Dihydrogen Phosphate
• Disodium Hydrogen Phosphate Dihydrate
• Water

The Hyaluronic Acid does the heavy lifting, so to speak. It replenishes the joint’s synovial fluid.

Whereas the remaining excipients collectively adjust the osmolarity, maintain the pH balance, protect against degradation, and keep the injection sterile.

Even though they are generally considered safe, individual sensitivities or allergies can exist. This caution is especially relevant for patients with a history of allergies to pharmaceutical excipients.

Always ask the clinic or doctor who’ll be administering any type of HA injection about the inactive ingredients. What are they? Do they pose a risk of an allergic reaction or other adverse complications?

Are There Better Alternatives to Durolane?

In terms of other brands which offer Hyaluronic Acid injections, there are quite a few.

And we have reviewed the top ones:

• Ostenil
• Cingal
• Monovisc
• Synvisc

You can view each one to learn more.

Some of these other brands might be more befitting to your needs.

So it’s difficult to say whether they are “better” than Durolane because that depends on multiple factors.

Not to mention, there are numerous other regenerative modalities which have been proven to be efficacious in the treatment of osteoarthritis and other musculoskeletal problems. Such treatments are PRP, enriched PRP, nStride, Stem Cells, Arthrosamid, Goldic, Corticosteroids and more.

We have reviewed all of them meticulously. To learn more check out our Research page.

And if you’re feeling overwhelmed with all the possible treatment options, don’t be.

We can help you pick the best one for your particular condition and circumstances.

Scroll to the bottom of this article, to get bespoke guidance.

The Verdict – Is Durolane an Effective Treatment?

Durolane has been proven both empirically and anecdotally as an effective treatment for people suffering from joint pain and stiffness due to osteoarthritis.

Durolane injections contain hyaluronic acid (HA), which supplements the synovial fluid within the joint, directly addressing the root cause of osteoarthritis. This results in decreased pain, diminished stiffness, and enhanced mobility.

Reflecting on the empirical data and patient experiences discussed in this article, Durolane injections have shown clear clinical efficacy.

Nevertheless, the impact of Durolane can differ from person to person.

A significant number of patients report near-miraculous relief from osteoarthritis symptoms, enabling them to resume normal function and enjoy life without pain.

However, like any medical treatment, the outcomes can depend on several factors including:

• The severity of osteoarthritis.
• The specific joint(s) affected.
• The doctor’s level of injection proficiency and overall care.
• Is the doctor using ultrasound or landmark guidance? Preferably ultrasound.

In comparison to other available osteoarthritis treatments, such as corticosteroid injections, physical therapy, and oral medications, Durolane offers a targeted approach which mimics the body’s natural joint fluid. This provides a longer-term solution without the systemic side effects associated with oral pain relievers.