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

Sodium hyaluronate—found naturally in the body—acts as a lubricant and shock absorber in joints. Joints affected by arthritis may have less sodium hyaluronate, thus reducing the cushioning and lubrication in those joints.

Durolane injections contain highly purified hyaluronic acid that is placed directly in affected joints to increase the lubrication and cushioning, helping relieve pain experienced due to osteoarthritis. These injections provide symptomatic relief of OA and may delay the need for surgery on affected joints. 

Uses

Durolane injections are used most often to manage osteoarthritis in the knee that has not responded to other non-surgical treatment options. Occasionally, it is used in other joints, like the shoulder, hip, or ankle.

Durolane injections may be an option for individuals living with OA for whom conventional treatments, such as topical and oral nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, and corticosteroid injections, have not provided relief. Durolane may provide pain relief and help improve your capacity for physical activity.

Durolane benefits for those living with OA include: 

• Pain relief in the affected joint(s) 
• May help delay or avoid surgery
• Easy to administer
• Drug-free alternative to pain medications
• Repeatable—individuals may receive more than one shot if needed

Receiving a Durolane injection takes no more than 30 minutes. You will be awake during the procedure and will be given anesthesia on the skin where the injection will be administered to help reduce any discomfort felt during the procedure.

Before Taking

Talk to your healthcare provider about all medications, supplements, and vitamins that you currently take. While some drugs pose minor interaction risks, others may contraindicate use or prompt careful consideration as to whether the pros of treatment outweigh the cons in your case.

Precautions and Contraindications

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

Durolane is not currently approved for use by anyone 21 years old or younger, as its safety and effectiveness have not been tested in this age group. Tell your healthcare provider if you have ever had blood clots or circulation problems. 

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

Other Hyaluronic Acid Injections

There are a number of commonly prescribed medications (hyaluronan derivatives) that are similar to Durolane. These medications are injected into affected joints to increase the amount of protective fluid to decrease pain and improve mobility in the joints. These include: 

Keep in mind, though, that the American College of Rheumatology (ACR), in a 2020 guideline on osteoarthritis, has come out against the use of intra-articular (within the joint) injections that contain hyaluronic acid. The ACR has issued a strong warning against these injections in osteoarthritis of the hip and a conditional warning against injections in osteoarthritis of the hand and knee. The guideline notes that the evidence of benefit favors injections of corticosteroids, which are conditionally recommended in OA.  

Dosage 

Durolane is administered by your healthcare provider in a single syringe containing 3 milliliters (ml) of gel. It is a single dose, and only one dose should be injected per joint. Durolane should only be injected by a qualified healthcare professional and is not intended for at-home use.

Each injection may provide relief from osteoarthritis symptoms for up to six months. Pivotal clinical studies show that many patients experience significant relief from osteoarthritis symptoms within only two weeks after injection.

Administration

Before administering the injection, your healthcare provider will clean the affected area. Then, your healthcare provider will inject a local anesthetic to prevent discomfort during the procedure. 

If your joint is swollen with excess fluid due to inflammation, your healthcare provider may first inject a local anesthetic before inserting a needle to withdraw excess fluid and relieve pressure. Your healthcare provider will then inject the Durolane into the affected joint.

Your healthcare provider may use imaging studies to guide the injection needle into the affected area. Following the injection, ice will be applied to the area and you will be required to rest in the recovery area to ensure there are no adverse effects. Most patients can return home on the same day. 

After the injection, your healthcare provider will place a small bandage or dressing over the injection site. You will also be instructed to apply ice on the injection site at home to reduce pain and swelling.

Your healthcare provider may give you a repeated dose after this period. Durolane is proven safe for repeated treatments.

Avoid strenuous activity for at least 48 hours after your injection. This includes standing for longer than an hour at a time and weight-bearing activities. Speak with your healthcare provider to determine how long to wait before resuming these activities. 

Side Effects

Along with its desired effects to reduce pain, Durolane injections may cause some unwanted side effects. Some side effects may occur that do not require medical attention, as they are likely to go away after your body has adjusted to the medication.

Speak with your healthcare provider if the common side effects you are experiencing are persistent or bothersome.

Common

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

• Headache
• 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 side effects, seek medical attention: 

• Allergic reaction (redness, rash, hives)
• Bleeding
• Blistering or discoloration of the skin
• Hives
• Infection
• Itching

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

Warnings and Interactions 

You should not receive a Durolane injection if you had a previous allergic reaction to hyaluronic acid or if you have a bleeding disorder. 

There are currently no known drug contraindications with Durolane. This means that there are currently no other medications that contraindicate its use in osteoarthritis patients.