Osteoarthritis (OA) is a common degenerative joint disease that affects millions of people worldwide. It is probably the most common in that group of diseases and causes pain, stiffness, and limiting mobility due to the gradual breakdown of cartilage in the joints.
As people age, the risk of developing OA increases, and with the growing aging population, the prevalence of this condition will undoubtedly rise.

That’s why new ways of managing osteoarthritis are constantly sought to maintain quality of life. One very promising therapeutic approach is the use of hyaluronic acid (HA) injections.

We will explain how hyaluronic acid injections for osteoarthritis treatment work. We will also take a closer look at three leading HA products – Durolane, Synvisc, and Euflexxa – comparing their effectiveness and safety.

What Are Hyaluronic Acid Injections?

Hyaluronic acid orthopedic injections are a minimally invasive treatment used primarily to alleviate the symptoms of osteoarthritis.

They replenish the body’s natural HA levels within the synovial fluid. Once the situation improves in that area, patients will restore the joint’s natural lubrication, cushioning, and shock-absorbing abilities. This treatment is commonly administered directly into the affected joint. Knee, hip, and shoulder are most often targeted, but other joints are also considered.

The procedure is quick, non-surgical, and requires no hospitalization.

Benefits of Hyaluronic Acid Injections

Hyaluronic acid injections offer several notable benefits:

• Pain Relief: Numerous clinical studies, including a meta-analysis published in The Journal of Bone and Joint Surgery, have shown that HA injections can significantly reduce pain in OA patients. The injections can provide pain relief that is comparable to nonsteroidal anti-inflammatory drugs (NSAIDs), but without the systemic side effects associated with long-term NSAID use.
• Improved Joint Function: After receiving HA injections, many patients report noticeable improvements in joint mobility and function. These improvements can lead to better performance of daily activities, including walking, climbing stairs, and exercising.
• Reduction of Inflammation: Hyaluronic acid has anti-inflammatory properties. This leads to a reduction in inflammation in the joint’s synovial lining. Slowing the progression of OA is a direct consequence of that because one of the main causes of joint deterioration is eliminated.

Indications for Use

First line of treatments are mostly physical therapy, weight management, and oral pain relievers.

Once everything fails, hyaluronic acid injections are the next line of defense. HA injections are particularly useful for patients who are not yet candidates for joint replacement surgery or those who are looking to delay surgery as long as possible. Even athletes and very active people can benefit from it.

Durolane vs Synvisc vs Euflexxa

Now, it’s time to break down these three premium products.

Durolane

Durolane is a single-injection hyaluronic acid (HA) product known for its high concentration of cross-linked HA, providing long-lasting relief from osteoarthritis (OA) symptoms. Unlike some other HA injections that require multiple treatments, Durolane’s single-shot formulation is designed to provide relief for up to six months. This convenience, coupled with its efficacy, makes it an appealing option for many OA patients.

One study highlighted notable improvements in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores post-treatment, indicating better mobility and less pain in patients suffering from knee OA. Its higher HA concentration contributes to its extended duration of effectiveness, providing patients with an efficient and long-term treatment option.

Synvisc

Synvisc is a more traditional HA formulation, containing Hylan G-F 20, a gel-like substance that mimics the natural properties of synovial fluid. It is typically administered as a series of three weekly injections. Synvisc’s viscous nature allows it to provide significant lubrication and shock absorption, protecting the joint from further wear and tear.

The multi-injection approach ensures a gradual buildup of HA in the joint, which can extend its effects. Clinical studies have shown that benefits often last up to six months after the third injection. This makes it a reliable option for patients seeking sustained relief from OA symptoms, particularly in the knee. Its long-standing use and extensive research behind it further support its role in OA management.

Euflexxa

Euflexxa, a non-animal-derived HA product, is known for its high purity and is administered in a series of three injections over a three-week period. Its non-animal origin is a key differentiator, making it suitable for patients who may have allergies to avian-based products like Synvisc. Clinical studies have demonstrated that Euflexxa significantly reduces pain and improves mobility in patients with knee OA.

A study published in The Clinical Journal of Pain showed that patients receiving Euflexxa experienced both a reduction in pain and improved mobility. This makes Euflexxa a preferred option for individuals seeking effective, animal-free HA injections for osteoarthritis.

Efficacy and Clinical Outcomes

When it comes to the efficacy of Durolane, Synvisc, and Euflexxa, clinical studies indicate that all three products provide effective pain relief and improved joint function in osteoarthritis patients. A systematic review comparing the three HA formulations found that they are similarly effective in alleviating symptoms, with all showing significant improvements. However, individual responses to these treatments may vary depending on factors such as the severity of OA, patient health, and specific joint conditions.

Patients with mild to moderate OA may benefit more from these injections, particularly those who are not yet candidates for surgical interventions like knee replacements. As research progresses, HA injections continue to be validated as a reliable, non-invasive treatment option for managing OA symptoms.

Safety and Side Effects

The safety profiles of Durolane, Synvisc, and Euflexxa are generally favorable. Most patients experience minimal side effects. Those are usual things like temporary pain, swelling, or mild injection site reactions. These symptoms tend to disappear within a few days.

More serious adverse events are rare but can include synovitis (inflammation of the joint lining), allergic reactions, or infection at the injection site. For Synvisc, which is derived from avian sources, allergic reactions to avian proteins are a potential risk, making it unsuitable for people with sensitivities to bird products.

It’s important to note that these injections should not be used in patients with active joint infections or those with known hypersensitivities to any of the product ingredients. To minimize complications, patients are often advised to avoid strenuous activities for at least 48 hours following treatment. This precaution reduces the likelihood of irritation or additional strain on the treated joint.

Cost Considerations

The cost of hyaluronic acid injections for osteoarthritis varies. These prices can fluctuate based on factors such as geographical location, healthcare provider pricing, and insurance coverage. On average, in the United States, the price for a single injection of Durolane can range from $200 to $600, depending on the provider and region. Given that Durolane is a one-time injection, patients may find it more cost-effective in the long term.

Synvisc, administered as a series of three injections, costs between $400 to $1,000 for the full course. While the upfront cost may seem higher, a couple of injections are better for those needing consistent treatment throughout the year.
Euflexxa, like Synvisc, requires a series of three injections, with an average cost ranging from $300 to $800 for the complete treatment. So, Euflexxa is a slightly more affordable option compared to Synvisc, thus patients without sensitivities to animal-derived products can take advantage of that price.

Many insurance plans in the U.S. cover hyaluronic acid injections for osteoarthritis, but reimbursement policies vary. Therefore, out-of-pocket costs and insurance coverage must be checked before starting treatment.

Administration and Follow-Up

How the patient will receive hyaluronic acid and subsequent check-ups are equally important as the selection of the product.

First and foremost, the environment must be sterile to prevent infections. This means using clean, sterile gloves, properly preparing the skin with antiseptic, and handling the needle carefully.

Using ultrasound or other imaging guidance is highly recommended. It allows for precise placement of the injection into the joint. Research shows that guided injections are more accurate than doing it blindly. This way, numerous issues for patients can be avoided, especially in areas like the hip, where the procedure can be very tricky.

After the procedure, patients must receive clear instructions. They should rest the joint for a day or two, avoid heavy physical activity, and watch out for any signs of infection.

It’s a good idea to check in with the patient about six weeks after the injection to see how their pain and mobility are improving, and then again around six months to assess longer-term results.

Conclusion

These injections are amazing because they help patients with the root issue and not just symptomatically.

In comparing the leading products – Durolane, Synvisc, and Euflexxa – it’s clear that each has its unique advantages. Durolane stands out for its single-injection regimen, Synvisc for its longer history and multi-injection approach, and Euflexxa for its non-avian origin, making it an option for patients with sensitivities. The choice of product should always be in accordance with unique patient characteristics.

As osteoarthritis research progresses, we can expect to see even more treatments and approaches to managing this widespread condition. By staying current on these advancements, we can make osteoarthritis management very successful. Continued focus on innovation and individualized care will remain central to achieving these goals.

Frequently Asked Questions (FAQ)

How do hyaluronic acid injections compare to corticosteroid injections for managing osteoarthritis pain?

Hyaluronic acid injections tend to offer longer-lasting relief compared to corticosteroids, which may provide more immediate but shorter-term pain relief. While corticosteroids can reduce inflammation quickly, they may not address the underlying joint degeneration as effectively as hyaluronic acid. Choosing between these options depends on individual patient needs and treatment goals.

Can hyaluronic acid injections be used in conjunction with other treatments for osteoarthritis?

Yes, hyaluronic acid injections can be effectively combined with other treatments, such as physical therapy, pain medications, or lifestyle modifications. This multimodal approach can enhance overall treatment outcomes by addressing various aspects of osteoarthritis management.

What are the storage requirements for hyaluronic acid injection products before administration?

Hyaluronic acid injection products should be stored at controlled room temperatures, between 20°C and 25°C (68°F and 77°F). It is essential to keep them protected from light and avoid freezing. Proper storage ensures the effectiveness of the product prior to administration.

Are there alternative natural therapies to hyaluronic acid injections for managing osteoarthritis?

Several alternative therapies can complement or serve as substitutes for hyaluronic acid injections. Those are glucosamine and chondroitin, acupuncture, and physical therapy. Some patients may also explore natural anti-inflammatory approaches such as omega-3 fatty acids or turmeric.

What advances are being researched in hyaluronic acid formulations for osteoarthritis treatment?

Recent research is focusing on developing more effective formulations of hyaluronic acid, including cross-linked versions that provide prolonged relief and improved joint lubrication. Studies are also exploring combination therapies that integrate hyaluronic acid with other anti-inflammatory medications.

References

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De Lucia O, Murgo A, Pregnolato F, Pontikaki I, De Souza M, Sinelli A, Cimaz R, Caporali R. Hyaluronic Acid Injections in the Treatment of Osteoarthritis Secondary to Primary Inflammatory Rheumatic Diseases: A Systematic Review and Qualitative Synthesis. Adv Ther. 2020 Apr;37(4):1347-1359. doi: 10.1007/s12325-020-01256-7. Epub 2020 Mar 5. PMID: 32141016; PMCID: PMC7140740.

Lee MI, Kim JH, Kwak HH, Woo HM, Han JH, Yayon A, Jung YC, Cho JM, Kang BJ. A placebo-controlled study comparing the efficacy of intra-articular injections of hyaluronic acid and a novel hyaluronic acid-platelet-rich plasma conjugate in a canine model of osteoarthritis. J Orthop Surg Res. 2019 Sep 18;14(1):314. doi: 10.1186/s13018-019-1352-1. PMID: 31533754; PMCID: PMC6749694.

Wang CT, Lin J, Chang CJ, Lin YT, Hou SM. Therapeutic effects of hyaluronic acid on osteoarthritis of the knee. A meta-analysis of randomized controlled trials. J Bone Joint Surg Am. 2004 Mar;86(3):538-45. doi: 10.2106/00004623-200403000-00012. PMID: 14996880.