What is intra-articular (joint) Durolane injection?
Durolane is a purified form of Hyaluronic acid. Hyaluronic acid is a substance naturally found in the lining of joints (called the synovial membrane), acting as a shock absorber and lubricant. In general, arthritic joints have less or inefficient Hyaluronic acid, so they have less protection, shock absorption and cushioning effect when compared to normal joints. Durolane injection sometimes is referred to as “Viscosupplementation”, which means supplementing the viscous fluid within the joint that is responsible for the cushioning and protective effect.
How is Durolane made?
Durolane is produced artificially using special bacteria. The production process changes the consistency and shape of the hyaluronic acid molecules so they become more efficient.
What are Durolane injections used for?
Durolane injections efficiently treat osteoarthritis (wear and tear changes to the joints). In general, the treatment of osteoarthritis starts with physiotherapy, strengthening exercises, and weight loss. Anti-inflammatory tablets (like ibuprofen) are also useful for treatment but are not always well-tolerated by patients. If the above conservative treatment is not effective, then there might be a role for injection therapy in the management of osteoarthritis.
Are Durolane injections useful for the management of osteoarthritis?
There is enough evidence to suggest that Durolane is useful for the management of osteoarthritis. Hyaluronic acid injections are most useful in managing mild-moderate forms of osteoarthritis, and there is abundant evidence supporting their use in knee osteoarthritis. It can treat other joints (like hip and ankle joints), but more evidence is required to establish its efficiency in the treatment here.
The mechanism of action of Hyaluronic acid is multifactorial. First, it acts as a lubricant, ensuring smooth movement at the joint. Second, It cushions the joint to protect the articular cartilage and bone, particularly during activities. In addition, there is evidence that Durolane has an anti-inflammatory effect and eliminates toxic substances that can damage cartilage.
What are Durolane injections used for?
In general, we use Durolane injections for knee and hip arthritis that has not responded to simple treatments such as exercise, weight loss, physiotherapy and medications. In smaller volumes, Durolane injections are also used to manage osteoarthritis in other joints (like the ankle and sacroiliac joints).
How effective are Durolane injections for osteoarthritis?
Durolane is a purified form of Hyaluronic Acid, and it is one of the high molecular weight preparations of the medicine. Please see our article Intra-articular Hyaluronic acid injections to learn about the different types of Hyaluronic acid preparations. Overall, there is good evidence showing the high efficiency of Durloane injections in treating knee osteoarthritis. A study comparing the results of Durolane injections vs other non-surgical treatment options for knee joint osteoarthritis showed that hyaluronic acid was the most effective treatment option. The results of hyaluronic acid injections were similar to another injection treatment option for knee osteoarthritis, called platelet-rich plasma (PRP) injections. Furthermore, Durolane is a high molecular weight preparation of Hyaluronic acid, and there is evidence that such preparations are more effective in treating osteoarthritis, especially as a single injection. The low molecular weight Hyaluronic acid preparations (like Ostenil or Synvisc) needed multiple doses to achieve good results. A further large study was dedicated to assessing the effectiveness of Durolane injections and included a large number of patients who had either a hip or a knee joint Durolane injection (more than 700 injections in total) over 6 years period. The results of the study showed good results from the injections lasting for a long period of time, up to 400 days. There was also high satisfaction among the patients.
How is Durolane injected?
When Durolane is used for the treatment of osteoarthritis, it is injected into the joint. This is referred to as (intra-articular injection). Nowadays, most musculoskeletal injections (into joints, tendons or bursae) are done under image guidance to improve accuracy. Ultrasound is a convenient and accurate method for guiding injections when performed by an experienced doctor. It does not involve any ionising radiation exposure (unlike X-rays). In a large study that included more than 1000 patients who had hyaluronic acid injections for knee joint osteoarthritis, there were significantly fewer complications when compared to non-guided injections. In addition, A small number of patients ended up needing knee replacement (approx. 30% less compared to those who had their knee injections without ultrasound). Also, the ultrasound-guided injection group were less likely to need a steroid injection (approx. 27% less compared to those who had their knee injections without ultrasound guidance).
The procedure will take less than 30 minutes, and the actual injection should only take a few minutes. First, we will explain the procedure and complete a consent form. The knee will be scanned to determine the best site for the injection. The procedure will be done under strict sterile conditions, including skin preparation using an antiseptic solution, sterile gloves, a sterile probe cover and a sterile dressing pack. Then, under ultrasound guidance, Durolane will be accurately injected into the knee joint. Using ultrasound guidance usually minimises the pain during the procedure. After the injection, you must rest the knee and avoid strenuous activities for 48-72 hours. You should not drive home yourself, given an anaesthetic (numbing) medicine is usually included with the injection to ease the pain following the procedure.
How soon will Durolane injections start working, and how long will they last?
On average, the effect of intra-articular Durolane injections starts within the first 4 weeks after the injection. Overall, the evidence shows that the effect of the Durolane injections is longer when compared to other injection therapy options (like corticosteroids). One study showed good results for an average of 400 days when Durolane was injected into the knee or hip. In general, younger patients with milder osteoarthritis notice better results, but good results are also seen in elderly patients.
Can I have a repeat Durolane injection?
We do not recommend repeating Durolane injections sooner than 6 months from the last injection. Repeat injections have very good results, similar to the first injection, unlike corticosteroids, as the latter's efficiency can reduce with repeated injections.
What are the side effects of a Durolane injection?
Durolane is generally a safe medicine and is not associated with any significant adverse effects.
Side effects after a Durolane injection include:
Mild joint swelling (can last for a few weeks)
Joint pain (usually resolves after a week)
Mild stiffness around the joint
Severe joint swelling is rare. If this happens soon after the injection, it can suggest a condition called ‘pseudosepsis’. This is usually an allergic reaction to the injected medicine, and it’s rare (reported in approx. 1% of the injections),
Infection: this is very rare and reported in 1:10000 to 1:100000. It usually presents with swelling, pain, and warmth feeling to the joint, usually a few days after the procedure (not immediately). You may also notice generalised fever.
The above two complications are rare but serious. Such symptoms should not be ignored, and you need to seek urgent medical attention as further investigations (including knee fluid aspiration) and antibiotic treatment might be needed.
What are other available hyaluronic acid injection preparations?
In addition to Durolane, there are a few other types of hyaluronic acid injections available on the market, such as Ostenil and Synvisc. These differ from Durloane in terms of their molecular weight and viscosity. Durloane is considered a high molecular weight hyaluronic acid, while the other two types are low molecular weight ones.
Does the molecular weight of hyaluronic acid matter?
The most likely answer is yes, but more research is needed to answer this question. There is some controversy about which preparation (the high or low molecular weight) of hyaluronic acid is better for the purpose of Viscosupplementation. Please see our blog article about hyaluronic acid injections to find out more.
Durolane injection vs PRP (platelet-rich plasma)
Although there are no direct comparative studies comparing the two, evidence suggests that high molecular weight hyaluronic acid injections (like Durolane) have a similar effect to PRP injections. The beneficial results after Durolane injections are reported to be more consistent than the PRP results. In addition, Durolane is administered as one injection only, while the PRP treatment course usually requires up to three injections.
Summary
Durolane is a purified form of Hyaluronic acid, a natural substance found in the lining of our joints. Intra-articular Durolane treatment consists of a single injection of high molecular weight hyaluronic acid, and it is proven to be effective in the management of joint pain and osteoarthritis. Generally, it is our preferred injection option, particularly for mild and moderate forms of knee joint osteoarthritis.
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