Durolane: one injection, not a course of five
A single stabilised hyaluronic acid injection for knee arthritis, placed under ultrasound at the joint we treat more than any other.
Get the one-page sheetWhat it is
Durolane is a stabilised hyaluronic acid. Hyaluronic acid is something your knee already makes. It is what gives healthy joint fluid its thickness, and in an arthritic knee there is less of it and what remains is thinner than it should be.
The stabilising is the part that matters. Ordinary hyaluronic acid injections are cleared from the joint quickly, which is why they are usually given as a course of three to five visits. Durolane is cross-linked so it stays in the joint far longer, and the whole treatment is a single 3ml injection.
It is not a steroid and it is not a painkiller. It works by restoring some of the cushioning and lubrication the joint has lost.
What the research shows
The largest trial enrolled 442 people with painful knee arthritis and followed them for 26 weeks, double-blind. Around 45 per cent were responders at 12 weeks, meaning their pain score improved by at least 40 per cent. The benefit was still there at 26 weeks. No serious device-related adverse events were reported.
A separate randomised study compared a single stabilised injection against a five-injection course of standard hyaluronic acid. The single injection came out ahead on pain at 26 weeks, the patients needed less pain relief, and the overall cost of treatment was lower.
One appointment rather than five is not only more convenient. Every injection into a joint carries a small risk, so fewer of them is a clinical argument as well as a practical one.
Being straight with you
It does not suit everyone and it is not a repair. A knee with very advanced changes may get little from it, and we would tell you that at the assessment rather than take your money and find out.
Most people feel some soreness in the joint for a day or two afterwards. Keep that day light, then return to normal.
What happens afterwards
The injection is placed under ultrasound using an in-plane approach, so the needle is watched along its whole length into the joint space. The effect builds over the following few weeks rather than arriving immediately, so judge it at six weeks rather than six days.
We book the rehabilitation alongside it, and this is the part that decides how much you get out of the injection. The patients who do best are the ones who commit to the strengthening work afterwards. Resistance training is the treatment with the strongest evidence behind it for an arthritic knee. What the injection does is make the joint comfortable enough to load properly. It is what lets the strength work happen, rather than a substitute for it.
Try this first
- Give it six weeks before judging whether it has worked
- Book the strength work to start while the knee is comfortable
- Keep the day of the injection light, then go back to normal
- Bring any previous knee scans or reports to the assessment
Get it looked at if
- The knee is hot, swollen and you feel unwell with it. Contact us or your GP the same day.
- Pain climbing rather than settling beyond 48 hours after the injection
- An injection site that looks infected
- Tell us beforehand if you are diabetic, on blood thinners, or being treated for an infection anywhere
What we would do
An assessment with a scan of the joint, so we can see what we are treating and say whether this is a sensible option for your knee. If it is, the injection is done under ultrasound in the same visit, and the rehabilitation plan goes alongside it.
Want this as a one-page sheet?
The version we hand out in clinic. Print it, stick it on the fridge, work through it.
Related: Durolane injections · All patient guides · Our blog
This guide is general information about a common problem, not a diagnosis of yours. If something is not settling, or it does not match what is written here, come and get it looked at.