What to Know About Durolane Injections

Durolane is a clear gel containing hyaluronic acid that is injected into joints to relieve pain caused by osteoarthritis (OA). It differs from some other hyaluronic acid injections in that only a single injection is needed for six months, as opposed to the standard three- to five-injection cycle.

Hyaluronic acid (sometimes referred to as hyaluronan) is a naturally occurring compound found throughout the body that is used to lubricate joints and help heal wounds.

Durolane is a synthetic form of hyaluronic acid that is injected into a joint space to increase joint lubrication and cushioning. It differs from similar forms of hyaluronic acid in that it is more stable and degrades slower for a longer-lasting effect.

A single injection of Durolane not only improves joint mobility and decreases pain but can also delay the need for joint surgery or joint replacement surgery.

This article describes the uses and benefits of Durolane, including how the injection is administered. It also looks at possible risks, side effects, and contraindications.

Uses and Benefits of Durolane

Durolane injections are most often used to manage OA of the knee that has not responded to other non-surgical treatments. Occasionally, it is used in other joints, such as the shoulder, hip, or ankle.

Durolane injections may be a reasonable option for individuals with OA who have not had success with topical and oral nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, and corticosteroid (steroid) injections.The benefits of Durolane include:

• Longer-lasting joint pain relief (generally up to 26 weeks)
• Fewer injections than other hyaluronic acid products
• Drug-free relief, allowing for repeated injections whenever needed
• Delaying the need for joint surgery
  

Precautions and Contraindications

If you are allergic to hyaluronic acid, you should not be given a Durolane injection. You should also not receive Durolane if you have an active infection in the affected joint or the skin around the joint.

Tell your healthcare provider if you have ever had blood clots. While rare, hyaluronic acid has been known to cause blood clots in and around the injection site.

You should also avoid a Durolane injection if you have a bleeding disorder.

Durolane is not currently approved for people 21 years of age or younger as its safety and effectiveness have not yet been established. 

The safety and efficacy of Durolane have also not been established in people who are pregnant or breastfeeding. Talk to your healthcare provider if you are pregnant or nursing before receiving Durolane. 

Recommended Dosage 

Durolane is administered by a healthcare provider as an intra-articular injection (meaning an injection into an articulated joint). Durolane is packaged in a pre-filled syringe containing 3 milliliters (ml) of a sterile, saline-based gel.

Durolane is given a single dose, and only one dose should be injected per joint. Pre-market studies suggest that most people who get Durolane experience pain relief within two weeks.

How Durolane Injections Are Given

A Durolane injection is a simple outpatient procedure that can be performed in a healthcare provider's office.

Prior to the injection, imaging studies—such as an X-ray or computed tomography (CT) scan—may be ordered to direct the placement of the needle. Alternatively, a handheld ultrasound can provide live images to help guide the procedure.

The Durolane injection is typically administered in the following steps:

1. The affected joint will be cleaned with an alcohol-based antiseptic swab.
2. A local anesthetic will be injected around the joint to reduce discomfort. It generally takes 10 to 15 minutes before the joint is amply numbed.
3. If your joint is swollen with fluid due to an injury or infection, your healthcare provider may first extract the excess fluid with a syringe. This is referred to as arthrocentesis (or joint aspiration).
4. The cap from the pre-filled syringe is removed, and the content of the syringe is delivered at one or several sites within the joint space.
5. A cold compress or ice pack is applied to the joint after the injection, and you will be asked to rest in a recovery area to ensure there are no adverse effects. 
6. A small bandage or dressing may be applied before you are sent home.

You will be given instructions to rest once you return home and to apply ice to the joint to alleviate pain or swelling. Avoid strenuous activity for at least 48 hours, including any weight-bearing activity or standing for longer than one hour.

Speak with your healthcare provider to determine how long you need to wait before resuming normal activities. 

Possible Side Effects of Durolane

Durolane injections may cause unwanted side effects in some people. Most are mild and do not require medical treatment. With that said, some people have been known to react to hyaluronic acid (or other components of Durolane) and require medical attention.

Common

Some of the more common side effects of Durolane injection include:

• Headache
• Fatigue
• Joint pain
• Mild pain, warmth, and swelling at the injection site 
• Muscle pain or stiffness

Severe

Severe side effects from Durolane injections are rare. If you experience any of the following, seek medical attention:

• Rash or hives
• Prolonged or excessive bleeding
• Worsening redness, warmth, pain, or swelling
• A pus-like discharge
• Fever with chills
• Dizziness or lightheadedness
• Nausea or vomiting

In addition to speaking with your healthcare provider, you can report any side effects to the Food and Drug Administration (FDA) at 1-800-FDA-1088.

Warnings and Interactions 

There are currently no known drug interactions associated with Durolane.

With that said, in 2019, the American College of Rheumatology came out against the use of intra-articular injections that contain hyaluronic acid.

Other forms of hyaluronic used for the treatment of OA of the knee and other joints include: 

• Euflexxa
• Gel-One
• Hyalgan
• Monovisc
• Orthovisc
• Supartz
• Synojoynt