Ostenil Injections: How Do They Work? Worth it?

Ostenil – 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 Ostenil in a table format:

Ostenil Rating:	7.5 / 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 1998.
Risks? (Side Effect Profile):	In most cases, minimal. Mild redness.
Treatment Duration:	1-3 injections, may need repetition.
Recovery Time:	Minimal. A day, or less than a week.
Cost-effectiveness:	Relatively cheap but beneficial.
Provider Expertise:	Moderate expertise is required.
Best Suited For:	Osteoarthritis (OA).

The Different Types of Ostenil

Ostenil is a brand name for an injection-based, osteoarthritis treatment.

The active ingredient is hyaluronic acid (HA) also known as sodium hyaluronate.

Often referred to as ‘viscosupplementation’, the primary purpose of injecting HA – is to replenish the body’s own joint fluid.

Osteoarthritis elicits changes in the joint’s cartilage, where the production of hyaluronic acid, begins to decrease. This eventually leads to increased joint pain and stiffness. Supplemental treatments like Ostenil aim to mitigate this joint fluid loss.

There are 4 different types of Ostenil injections:

Ostenil (Standard): The standard formulation, also known as just Ostenil, is designed for general use in treating osteoarthritis-related joint pain and stiffness. It is typically used in medium to large joints, such as the knees and the hips, providing relief by improving the lubrication and cushioning within the target joint.

Ostenil Plus: A more concentrated version, containing a higher dose of hyaluronic acid. Approximately 20 mg/mL (or 40 mg total per injection) of fermentative hyaluronic acid per syringe, with an average molecular weight of 1.6 million Daltons. For this reason, Ostenil Plus is made specifically for patients with more severe symptoms of osteoarthritis. It’s especially beneficial for those with significant joint pain and mobility issues (Ostenil injections, 1).

Ostenil Mini: Specifically designed for smaller joints, such as those in the hands, feet, and sometimes the temporomandibular joint (TMJ) in the jaw. Ostenil Mini contains approximately 10 mg/mL (or 20 mg total per injection) of fermentative hyaluronic acid per syringe with a much lower molecular weight of 150,000 Daltons. This makes it more suitable for the smaller volume and space within these joints, providing targeted relief from pain and stiffness (2).

Ostenil Tendon: This formulation is designed to treat tendon-related issues, which can be a source of pain and discomfort for individuals with osteoarthritis. It’s applied around the tendons to reduce inflammation and pain, facilitating smoother movement and function.

Therefore, depending on the type and severity of your condition, your doctor should prescribe the most appropriate version of Ostenil.

However, it’s advisable not to rush your treatment with Ostenil. There are other similar brands which offer hyaluronic acid injections. And some offer even higher doses or different versions of HA which may be more befitting for your specific case.

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

How Ostenil Provides Relief From Joint Pain

Ostenil injections are primarily designed to combat the symptoms of osteoarthritis, hence the name, Oste – nil.

But may also be prescribed for the treatment of pain and reduced mobility due to tendon disorders.

The key ingredient in Ostenil, hyaluronic acid, is injected directly into the affected joint.

That sounds painful – you might say.

Well, hyaluronic acid is naturally found inside the joints. However, osteoarthritis causes a significant reduction in both the concentration and quality of HA. This results in decreased lubrication and increased wear on the cartilage over time (3).

Healthy joints maintain a balance where the rate of natural cartilage degradation and regeneration are equal, ensuring joint integrity and function.

Osteoarthritis disrupts this balance, leading to a predominance of breakdown over repair, which results in joint pain, stiffness, and reduced mobility.

For this reason, by injecting exogenous hyaluronic acid we aim to restore said balance and supplement the natural joint fluid, providing more lubrication and cushioning.

And no, it’s not painful.

In most cases, a local anaesthetic will be applied to numb the area prior to the injection.

So you won’t feel much, if anything.

Ostenil Injections – Price

In the UK, Ostenil injection prices can range from £150 – £500+ per injection.

It depends on both the clinic and the type of Ostenil – either Standard, Ostenil Plus, Ostenil Mini or Ostenil Tendon.

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

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

And are Ostenil Injections available on the NHS?

Unfortunately, rarely.

Some NHS trusts might offer them, but only in specific regions. You’ll need to speak with your GP, or healthcare consultant. You can also try your local clinical commissioning group (CCG) as they might cover Ostenil.

But keep in mind it’s not available in primary care GPs. And more often than not it isn’t covered by CCGs (clinical commissioning groups), due to budget constraints.

Ostenil Injections – Patient Reviews

What do people who’ve had Ostenil say?

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.

This study (4) in particular, compared Ostenil PLUS® versus MONOVISC® (which is another brand of hyaluronic acid injections).

The results showed no significant difference between the two products, except for the WOMAC stiffness score.

“The WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) is a self-administered osteoarthritis questionnaire assessing pain, stiffness, and physical function through ranked responses, where higher scores denote worse conditions.“

With Ostenil Plus, there was a notable WOMAC stiffness score improvement at month 1, which also persisted at months 3 and 6.

Whereas with Monovisc, there was also a notable WOMAC stiffness score improvement at month 1 but it did not persist at months 3 and 6.

Therefore, inferring from this preliminary data, Ostenil Plus seems to offer more long-lasting results.

But this study has a few noteworthy limitations.

Firstly, patients were allowed to use Non-steroidal anti-inflammatory drugs (NSAIDs) and other analgesics, such as ibuprofen etc.

Also, as a part of the study’s design, patients were instructed to use diclofenac potassium, another NSAID.

And finally, there was no placebo control group.

Anecdotal:

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

We took all the reviews we could find (upwards of 200). We analysed them all, and here’s the collective voice:

Almost all patients experienced a tangible improvement. Meaning less pain, less joint stiffness and better range of motion within the first week after having Ostenil. And this improvement lasted multiple months. And very few experienced side effects, mostly mild redness around the injection site.

This corroborates the findings we quoted above.

So our consensus is that Ostenil is one of the more promising HA injection brands, however, it must be administered by an experienced injection specialist with ultrasound guidance.

Otherwise, complications may occur or Ostenil 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?

The Ostenil 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 Ostenil into the affected joint.

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

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

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.

What Are The Side Effects of Ostenil?

Ostenil was introduced to the market in 1998 by TRB Chemedica.

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

Hundreds of thousands of people have had Ostenil 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 Ostenil. 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 Ostenil is considered generally very safe.

But it’s important to note that Ostenil should not be used in children, pregnant and lactating women or in people with inflammatory joint diseases such as rheumatoid arthritis or Bechterew disease.

How Safe is Ostenil Compared to Others?

If we go back to the same study (4), we quoted above, which compared Ostenil PLUS® versus MONOVISC®, only 2 patients in the cohort of 74 (28 Ostenil and 46 Monovisc) experienced these mild side effects, such as joint swelling and redness within the first week. The remaining 72 patients had no side effects.

Another study (5) compared Ostenil, Synvisc and Curavisc (two other hyaluronic acid injection brands).

The research revealed that Synvisc most frequently resulted in pseudosepsis.

The hyaluronic acid in Synvisc is derived from rooster combs which are the fleshy, red growths on the top of a chicken’s head (6).

It later undergoes a rigorous purification process, before it is chemically modified to form “hylan G-F 20” – the active substance in Synvisc.

However, since “hylan G-F 20” has avian origins (chicken), it can potentially trigger an immune response and lead to more adverse reactions.

Whereas, the hyaluronic acid in Ostenil is produced through the fermentation of ‘Streptococcus zooepidemicus’ – a specific bacteria strain.

This method involves cultivating these bacteria, which are capable of producing hyaluronic acid as part of their metabolism, in controlled bioreactors.

The bacterial fermentation process for producing HA has two main advantages:

1. Low in Allergens: Since it’s not derived from animal sources, HA produced through bacterial fermentation reduces the risk of allergic reactions related to avian proteins. This makes it suitable for patients sensitive to bird products.
2. High Purity and Consistency: Bacterial fermentation allows for the production of HA with high purity and consistency. The process can be tightly controlled to yield HA of specific molecular weights and concentrations suitable for medical use.

Therefore Ostenil seems to be amongst the safer and more effective forms of injectable hyaluronic acid.

How to Prevent Side Effects?

To prevent or minimise the risk of side effects from Ostenil 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 (7) 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 (8). 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 Ostenil. 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 Ostenil is:

• Hyaluronic Acid (fermentation via Streptococcus zooepidemicus)
• Sodium Chloride
• Disodium Phosphate
• Sodium Dihydrogen Phosphate
• Mannitol
• 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 Ostenil?

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

And we have reviewed the top ones:

• Durolane
• 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 Ostenil 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 Ostenil an Effective Treatment?

Ostenil offers a viable solution for individuals seeking relief from joint pain and stiffness as a result of osteoarthritis.

Ostenil injections contain hyaluronic acid (HA) which replenishes the synovial joint fluid. This tackles one of the root causes of Osteoarthritis. Resulting in less pain, reduction in stiffness and improved mobility.

Based on the empirical evidence and patient data reviewed in this article, Ostenil injections have demonstrated sufficient clinical efficacy.

But the effectiveness of Ostenil can vary among individuals. Many people experience significant relief from OA symptoms which enables improved quality of life and increased physical activity.

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, Ostenil 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.