Osteoarthritis Clinic · Injection guide

Viscosupplementation (Durolane)

A gel-like hyaluronic-acid injection meant to lubricate and cushion an osteoarthritic joint. The evidence is genuinely mixed and there is a fee, so it is worth understanding the benefits, the risks with numbers, and the aftercare before you decide.

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What it is

Hyaluronic acid is a substance your joints make naturally. It helps the joint glide and absorb load. In osteoarthritis, this fluid thins out. Viscosupplementation adds hyaluronic acid back into the joint. We use Durolane, a single 3 mL injection containing 60 mg of purified sodium hyaluronate made by fermentation (non-animal stabilized hyaluronic acid, or NASHA). It is designed to stay in the joint for around a month while the effect builds over the following weeks.

The fee

Durolane is not covered by OHIP, so there is an out-of-pocket cost. The clinic will confirm the current fee with you before you book.

What the evidence shows

Studies disagree. Some people get useful relief that can last up to about six months from a single injection, and it may work as well as a course of several older hyaluronic-acid injections. Across high-quality reviews, though, the average benefit over a placebo injection is small and not always meaningful. It tends to help more in mild-to-moderate arthritis and less in advanced, bone-on-bone joints. Expert groups differ: some, such as OARSI, suggest it for selected people who are not ready for surgery, while others, such as the American Academy of Orthopaedic Surgeons, do not recommend it. We will talk through whether it is reasonable for your joint and goals.

The risks, in numbers

Durolane is generally well tolerated, and being non-animal it carries a low risk of allergy. The main issues are local. Based on the product information and published literature:

RiskHow often, and what it means
Local reaction or flareThe most common effect. Temporary pain, swelling, or warmth at the joint, usually settling within a few days. Injection-site reactions are reported in about 2 to 3 in 100, and a temporary increase in joint pain in up to about 9 in 100.
Joint swellingMild to moderate swelling in roughly 1 to 2 in 100.
Pseudoseptic reactionVery rare. A sudden, painful, swollen joint within a day or two that can look like an infection but is not. It still needs urgent assessment to rule out true infection.
Infection (septic arthritis)Rare, in the same low range as any joint injection.
Allergic reactionRare. Signs would include hives, swelling of the face or throat, or trouble breathing, which need emergency care.

After your injection

  • For at least 48 hours, avoid jogging, high-impact sport, heavy lifting, and standing for more than an hour at a time.
  • Rest the joint and use ice for any initial soreness or swelling.
  • Keep the injection site clean and dry.
  • Relief builds over the following weeks rather than straight away, so give it time.

The injection aftercare guide has the full version of this advice. For gentle exercises to do at home as the joint settles, see the knee home exercise programme.

!When to seek urgent care. Call the clinic or seek care if the joint becomes hot, very swollen, or increasingly painful in the days after the injection, if redness spreads, or if you develop a fever above 38°C (100.4°F). A sudden very painful, swollen joint needs to be checked promptly to tell a harmless reaction from a true infection.
This is general information, not medical advice. Whether viscosupplementation is right for you depends on your joint, the stage of the arthritis, and your goals. Your clinician will help you decide.