Role of geniculate artery embolization in the treatment of knee pain secondary to osteoarthritis

Abstract

Background Osteoarthritis (OA) is a leading cause of chronic knee pain and disability with a reported prevalence of 25–30% of the population. Knee OA has traditionally been thought as a degenerative disease only related to chronic repetitive injury “wear and tear” mechanism, yet it is now considered as a much more complex disease of inflammatory nature induced by cytokines and inflammatory mediators through abnormal neo-vascularization (angiogenesis). The rational of geniculate artery embolization (GAE) is based on the hypothesis that suggesting a direct relationship between the abnormal angiogenesis and the chronic knee pain. As a novel treatment option based on occlusion of these abnormal neo-vessels via geniculate artery embolization, we postulated that such a mechanism will relieve pain and improve the quality of life. GAE has been previously approved as a safe and effective treatment in cases of post-knee arthroplasty hemarthrosis. Purpose To evaluate the feasibility, safety, and efficacy of geniculate artery embolization for OA-related knee pain. Materials and methods Sixteen patients with knee pain secondary to chronic OA refractory to conservative therapies for at least 6 months and not yet fit for total knee replacement were enrolled in a prospective single arm interventional study. GAE was performed using 150–300 μm microspheres. Patients were assessed and followed up using the visual analogue scale (VAS) for pain and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for the overall knee function at baseline and at 1 week, 1, 3, and 6 months post-embolization. Results A total 16 patients presented by knee pain secondary to chronic OA were enrolled. All of them showed a remarkable improvement in the VAS and WOMAC scores, with better clinical outcome after GAE. Pre- versus post-embolization ± MDs in VAS score from 8.38 ± 0.81 (baseline) to 2.88 ± 1.54 after 6 months (post-embolization) equivalent to 66.66% improvement. There was also a satisfactory improvement in the WOMAC scores, with ± MDs drop from 77.94 ± 10.62 (baseline) to 49.69 ± 15.43 (post-embolization) equivalent to 37.41% improvement. No severe or life-threatening complications were reported. Conclusions GAE holds promise as an effective minimally invasive procedure for the treatment of knee pain secondary to OA and could be introduced as a safe technique with no serious complications.