"Synvisc", "Fermatron" or "Noltrexin"?

Comparison of the main characteristics of liquid endoprostheses

"Duralan" or "Noltrexin"?

Instead of painkillers and endless physiotherapy, today orthopedists recommend patients a course of intra-articular injections of a synovial fluid substitute. The drugs provide long-term relief from pain and discomfort and restore the physiological viscosity of the fluid.

Many people have no doubt about the effectiveness of this method for a long time. The question is: which of the many endoprostheses to choose? Let's consider two imported drugs - the English Duralan and the Swiss Noltrexin.

"Duralan" and "Noltrexin": what's inside?

• "Duralan"

Unlike many other liquid prostheses based on hyaluronic acid, Duralan is produced on the basis of highly purified non-animal hyaluronic acid. Due to its synthetic nature, it does not cause rejection reactions or allergies, and lasts longer than classic gels with sodium hyaluronate.

The English manufacturer uses a patented NASHA hyaluronic acid stabilization process. The result is molecules with strong bonds that take a long time to break apart. This explains such a long-lasting effect - 6-12 months - which cannot be obtained using other endoprostheses with a similar low molecular weight (1 million Da).

• "Noltrexin"

Swiss "Noltrexin" is also of synthetic origin, but has nothing to do with hyaluronic acid. The polymer consists of molecules with ultra-dense cross-linking. Such strengthened bonds are very difficult to break; moreover, the molecular links have an increased length (molecular weight - 12.5 million Da!). Thanks to these factors, the drug remains in the joint cavity for a long time and provides an effect of up to two, and sometimes up to three years.

"Duralan" - synovial fluid prosthesis based on synthetic hyaluronic acid

Differences between the drugs "Duralan" and "Noltrexin"

In what cases are both drugs used?

The instructions for the English Duralan endoprosthesis indicate that the drug is intended for the treatment of mild to moderate arthrosis of the knee and hip joint. In advanced cases, when joint mobility is severely limited due to osteophytes, the cartilaginous surfaces are excessively worn out and pain is always present, this prosthesis should not be used. With such a clinical picture, Noltrexin will help - it is effective in both the early and late stages of arthrosis.

The English manufacturer indicates in which cases Duralan should be used. It is recommended if non-steroidal anti-inflammatory drugs no longer control the clinical signs, and also if physical therapy no longer provides relief to the patient. A somewhat unexpected positioning of a medicine that theoretically should help much earlier and save the patient from the need to take a large number of harmful pills.

"Noltrexin", according to the instructions, is suitable for the treatment of arthrosis at all stages. The earlier the disease is detected, the easier it is to stop and keep it under control - fewer injections will be needed per course, and the breaks between courses will be longer.

Noltrexin is suitable for the treatment of arthrosis at all stages

What to choose?

According to the mechanism of action, both drugs are identical - they restore the viscosity and volume of synovial fluid in the joint, retain moisture and perform shock-absorbing functions. "Duralan" has some limitations - according to the instructions, it is intended only for the knee and hip joint with mild to moderate manifestations of arthrosis.

Noltrexin is a more universal drug. It can be used on patients of all ages at different stages of the disease, on all large joints, not just the lower extremities. Another undoubted advantage is a very high molecular weight and, as a result, an extremely long-lasting therapeutic effect, up to two years.

Few orthopedists know about such a feature of Noltrexsin as the ability to block substances that destroy the joint from the inside. The drug acts in a complex manner - mechanically and at the chemical level, remains in the joint for a long time, therefore it looks much more advantageous than the also synthetic "Duralan".

What determines the duration of the effect?

"Fermatron" and "Synvisk" are preparations based on hyaluronic acid, which are produced using autoclaving technology. Under the influence of high temperatures, not only does the death of pathogenic microorganisms occur, but also the disintegration of the active substance is accelerated. Molecules of hyaluronic acid that enter the joint as part of the endoprosthesis quickly disintegrate and are excreted from the body, ceasing their effect.

Noltrexin is a synthetic drug with an improved formula and high molecular weight. It is characterized by very dense cross-linking of molecules. During the production process, they are not autoclaved like hyaluronic acid, so they retain their original structure for a long time and remain in the joint.

Synthetic Noltrexin does not cause allergic reactions

The relevance of hyaluronic acid injections into the knee and other joints

Joint diseases are widespread among people around the globe. Recently, there has been a tendency towards an increase in the incidence of this group of pathologies, as well as its “rejuvenation”.

This is due to many factors, in particular:

• deterioration of the environmental situation, and, as a consequence, disruption of bone mineralization and other metabolic processes in all human tissues;
• an increase in average life expectancy, which, of course, leads to an increase in the number of diseases in older people, which include degenerative joint pathologies;
• obesity is a problem that is increasing in scale and causing increased stress on the joints;
• hormonal changes in the body of both men and women are associated not only with age-related changes in the body, but also, often in our time, with the use and receipt of hormonal and other drugs with food that change a person’s hormonal profile;
• receiving specific sports loads, and for professional athletes they are often excessive and lead to injuries, and for amateurs they are unsystematic and often without observing safety precautions, which ultimately also leads to injuries;
• a sedentary lifestyle is becoming more and more common; muscle weakness progresses over the years and, as a result, the risk of joint injury increases;
• an increase in the number of people with genetic and immune diseases who have various disorders of the structure and function of joints as a symptom;

The joint has a complex structure, and disruption of at least one of its elements leads, over time, to the spread of the problem to all its structures. That is why the relevance of new solutions is growing not only in surgical traumatology and orthopedics, but also in the means of conservative treatment of joints. These agents include hyaluronic acid, which is part of the synovial fluid and is an important component of articular cartilage, contributing to its elasticity.

Why do orthopedic traumatologists recommend liquid endoprostheses with high molecular weight

Hyaluronic acid molecules, which are most often used in preparations for the treatment of arthrosis of the knee or hip joint, are peculiar chains. Molecular mass is an indicator of the length of such molecules, the number of components in them into which the molecule gradually breaks down. The longer the chain and the more links it has, the longer it will take to disintegrate. Therefore, drugs with high molecular weight remain in the joint longer and at the same time:

• perform a shock-absorbing function - soften the friction of damaged cartilage;
• moisturize dried surfaces;
• become a favorable environment for the synthesis of their own synovial fluid;
• relieve pain.

When treated with Fermatron and Synvisk, improvements usually occur after the third injection

Comparison of molecular weight of liquid endoprostheses

The molecular weight directly affects the duration of the effect. For Fermatron, this figure is only 1 million Da - the chain is relatively short, disintegrates quickly, so after 3-5 months the treatment of arthrosis of the ankle, knee or elbow must be repeated.

Synvisk has a molecular weight of 6 million Da, that is, the length of the molecule is conditionally 6 times greater than that of Fermatron. In practice, this liquid prosthesis lasts not 6 times longer, but 2-3 times longer - in the range of 6-12 months.

Noltrexin has the largest molecular weight - 12 million Da. It contains the longest molecules, reinforced with special cross-linking. Therefore, it takes much longer for them to disintegrate. There have been cases of extremely long-lasting effects of the drug – up to 3 years! Under normal conditions, it remains in the body for up to 24 months. During this time, the person can move freely and use the joint without restrictions.

Noltrexin has the largest molecular weight among all liquid endoprostheses

What to choose?

Faced with the need to treat osteoarthritis of the elbow, knee or hip, athletes often focus on popular brands. Especially if their attending physicians, who are accustomed to prescribing conventional drugs based on hyaluronic acid, adhere to the same position.

Progressive sports traumatologists and orthopedists have long paid attention to the synthetic Swiss “Noltrexin” - primarily for its record high molecular weight. The drug costs slightly more than other drugs, but this overpayment is quite imaginary. You pay for one course, which lasts for up to two years, while in the case of Fermatron, over these two years you will have to pay for several more such courses.

Do not forget about the synthetic origin of Noltrexin. Unlike Fermatron and Synvisk based on hyaluronic acid, which may contain allergenic traces of chicken protein, artificial viscoprosthesis of synovial fluid is completely safe!

When are hyaluronic acid injections prescribed?

Experts prescribe a course of injections according to indications:

• When the integrity of the articular cartilage is damaged.
• To reduce motor dysfunction.
• For osteoarthritis as one of the methods to prevent the development of the disease.
• For the treatment of pain and reduction of inflammation.
• To normalize the composition of intra-articular fluid after joint surgery, including after arthroscopy.

At the SportClinic, doctors use only high-quality drugs strictly according to indications for injection into large joints (knee, shoulder, elbow, hip, ankle), they have extensive experience in such prescriptions with results of their high effectiveness in complex treatment.