Durolane is not a steroid. It is a gel made of hyaluronic acid, a substance that occurs naturally in joint fluid. While both Durolane and steroid injections are used to treat osteoarthritis pain, they are completely different substances that work in different ways.
What Durolane Actually Is
Durolane’s active ingredient is sodium hyaluronate, a highly purified form of hyaluronic acid produced through bacterial fermentation. Each syringe contains 60 mg of this substance dissolved in a saline solution. The FDA classifies it as a hyaluronic acid device, not a drug, and it sits in an entirely separate category from corticosteroids.
The confusion is understandable. Both Durolane and steroid injections are delivered the same way (a needle into the joint), treat the same condition (osteoarthritis pain), and are often discussed side by side in a doctor’s office. But the similarity ends there.
How It Works Compared to Steroids
Healthy joints contain hyaluronic acid as part of the synovial fluid that cushions and lubricates cartilage. In osteoarthritis, that fluid breaks down and loses its ability to absorb shock. Durolane essentially tops up the joint’s natural cushioning. This approach is called viscosupplementation.
Steroids work through a completely different pathway. Corticosteroids suppress inflammation directly, which is why they can provide fast, dramatic pain relief. But that anti-inflammatory action doesn’t restore any of the joint’s natural lubrication or shock absorption.
Pain Relief: Short Term vs. Long Term
The timeline of relief is one of the biggest practical differences between the two. A meta-analysis comparing hyaluronic acid and corticosteroid injections for knee osteoarthritis found that steroids reduce pain more effectively in the first month. By three months, the two approaches perform about equally. By six months, hyaluronic acid pulls ahead with statistically significant better pain scores.
So if you need the fastest possible relief, a steroid injection has the edge. If you’re looking for something that lasts longer from a single treatment, hyaluronic acid products like Durolane tend to outperform steroids over the following months.
Side Effect Differences
This is where the distinction between the two really matters for patients. Hyaluronic acid injections are generally considered safe, with the most common side effects being temporary pain, swelling, or stiffness at the injection site. In one clinical trial, 8.6% of Durolane patients reported joint pain after injection, 2.3% had injection site pain, and 1.7% experienced joint swelling. No allergic reactions or acute inflammatory reactions were reported in controlled studies.
Corticosteroid injections carry a different risk profile. While they are widely used and effective, repeated steroid injections have been linked to suppression of cartilage repair, worsening of existing cartilage damage, degenerative changes in otherwise normal cartilage, and skin discoloration near the injection site. Steroids can also cause temporary blood sugar spikes, which is a concern for people with diabetes. These risks are why doctors typically limit the number of steroid injections you can receive in a given joint per year.
Hyaluronic acid is also considered safe for repeat courses, though the FDA notes that the effectiveness of repeated Durolane injection cycles has not been formally established in clinical trials.
Why Your Doctor Might Recommend One Over the Other
For a painful flare that needs quick control, corticosteroids are often the first choice. For patients who want longer-lasting relief, who have already had multiple steroid injections, or who want to avoid steroid-related risks, Durolane and other hyaluronic acid products offer a meaningful alternative. Some treatment plans use both at different points, since the two substances work through unrelated mechanisms.
Durolane’s main practical advantage over other hyaluronic acid brands is that it requires only a single injection per treatment course, while some competing products require a series of three to five weekly injections. This is possible because of its proprietary stabilization technology, which allows the gel to persist in the joint longer.
The bottom line: if you’ve been offered a Durolane injection and you’re concerned about receiving a steroid, you can set that worry aside. It contains no corticosteroids, carries none of the steroid-specific risks, and works through a fundamentally different mechanism in your joint.