Clinical Outcomes of Transcatheter Arterial Embolisation for Chronic Knee Pain: Mild-to-Moderate Versus Severe Knee Osteoarthritis

Lee, Sang-Hwan; Hwang, Jin Ho; Kim, Dong Hyun; So, Young; Park, Jihong; Cho, Soo Buem; Kim, Jeong Eun; Kim, Young Jae; Hur, Saebeom; Jae, Hwan Jun

doi:10.1007/s00270-019-02289-4

Cited by 101 publications

(70 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Laboratory and animal experiments have identified the role of neo-angiogenesis in the pathophysiology of knee OA, and this has emerged as a viable embolization target. Existing human data, including the current work, have all reported a consistent signal that GAE is safe, technically achievable, and beneficial in reducing pain, and functional limitation secondary to mild to moderate knee OA at early follow-up [8][9][10][11][12]. The current analysis is the largest reported cohort with mild to moderate knee OA undergoing GAE with a permanent embolic.…”

Section: Discussionsupporting

confidence: 60%

“…Okuno et al were the first group to describe their experience of genicular artery embolization (GAE) in patients with knee OA [8]. Since then, a small number of studies have reported on the role of GAE in the treatment of knee OA [8][9][10][11][12]. The Genicular artEry embolizatioN in patiEnts with oSteoarthrItiS of the knee (GENESIS) study investigates the safety and feasibility of performing GAE in patients with mild to moderate knee OA using permanent microspheres.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Genicular artEry embolizatioN in patiEnts with oSteoarthrItiS of the Knee (GENESIS) Using Permanent Microspheres: Interim Analysis

Little

Gibson

Briggs

et al. 2021

Cardiovasc Intervent Radiol

View full text Add to dashboard Cite

Purpose Planned interim analysis of GENESIS; a prospective pilot study investigating the role of genicular artery embolization (GAE) in patients with mild to moderate osteoarthritis of the knee using permanent microspheres. Methods Thirty-eight patients, median age = 60 (45–83), attended for GAE using 100–300 μm permanent microspheres. All patients had mild to moderate knee OA, resistant to conservative treatments over 6 months. Knee MRI was performed at baseline, and 12 months, enabling semi-quantitative analysis using Whole-Organ Magnetic Resonance Imaging Score (WORMS). Knee Injury and Osteoarthritis Outcome Score (KOOS) and visual analogue scale (VAS) (0–100 mm) were completed at baseline, 6 weeks, 3 months (n = 32), and 1-year (n = 16). Adverse events were recorded prospectively. Results Technical success of accessing and embolizing the target genicular arteries was 84%. Six patients were not embolized: four due to a presumed risk of non-target embolization, and two due to a lack of hyperaemic target. Mean VAS improved from 60 (SD = 20, 95% CI 53–66) at baseline to 36 (SD = 24, 95% CI 28–44) at 3 months (p < 0.001) and 45 (SD = 30, 95% CI 30–60) at 1-year (p < 0.05). All KOOS subscales showed a significant improvement at 6-weeks, 3-months, and 1-year follow-up, except function in daily living, which reached borderline significance (p = 0.06) at 1-year. Four patients experienced mild self-limiting skin discoloration over the embolized territory. One patient experienced a small self-limiting groin haematoma. WORMS scores at 1-year follow-up showed significant improvement in synovitis (p < 0.05). There were no cases of osteonecrosis. Conclusion GAE using permanent microspheres in patients with mild to moderate knee OA is safe, with potential efficacy at early follow-up.

show abstract

Section: Discussionsupporting

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Genicular artEry embolizatioN in patiEnts with oSteoarthrItiS of the Knee (GENESIS) Using Permanent Microspheres: Interim Analysis

Little

Gibson

Briggs

et al. 2021

Cardiovasc Intervent Radiol

View full text Add to dashboard Cite

show abstract

“…Eleven studies with a total of 225 participants (27% men; age range, 48-88 years) and 268 knees were included. 2 , 3 , 19 – 22 , 27 – 29 , 31 , 37 Different embolic agents were applied, including imipenem/cilastatin (n = 4 studies), Embozene (n = 7 studies), resorbable microspheres (n = 1 study), and polyvinyl alcohol (n = 1 study). Overall, 119, 72, 13, and 21 patients were treated with imipenem/cilastatin, Embozene, resorbable microspheres, and polyvinyl alcohol, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…The impact of GAE on changes in the VAS score was evaluated at 6 different time points; 1 study included day 1 postoperative assessment, which was not included in the pooled analysis, as presented in Figure 3. 21 Pre-and postembolization scores of each study were collected, and the pooled effect size was calculated at 1 week and at 1-, 3-, 3-62.6). P values were all <.00001); therefore, we could state that knee pain, based on the subjective measure of acute and chronic knee pain, had significantly improved even within the first week after GAE (equivalent to 54% decline).…”

Section: Effectiveness Of Gaementioning

confidence: 99%

Osteoarthritis-Related Knee Pain Treated With Genicular Artery Embolization: A Systematic Review and Meta-analysis

Torkian

Golzarian

Chalian

et al. 2021

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

Background: Genicular artery embolization (GAE) is an innovative technique that has been investigated as a supplementary treatment method for chronic pain secondary to knee osteoarthritis (OA). Purpose: To evaluate the current evidence on the effectiveness and safety of GAE for OA-related knee pain. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic literature search was conducted in the PubMed, Web of Science, EMBASE, and Scopus databases to identify studies related to knee OA treated with GAE. Treatment agents were categorized as Embozene, imipenem/cilastatin, resorbable microspheres, and polyvinyl alcohol. The main outcomes were the mean difference (MD) in pre- and postembolization pain based on the visual analog scale (VAS) or the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores as well as changes in the need for pain medication. Random- and fixed-effects models were applied for data analysis. Results: Of 379 initially inspected publications, 11 (N = 225 patients; 268 knees) were included in the final review. The quality of the studies was fair in 8 and poor in 3—categorized according to the National Institutes of Health quality assessment tool. Overall, 119, 72, 13, and 21 patients were treated with imipenem/cilastatin, Embozene, resorbable microspheres, and polyvinyl alcohol, respectively. Symptomatic improvement was reported in all studies. The pooled effect size, characterized by MD, showed a significant improvement in the VAS and WOMAC pain scores, with better functional status after GAE. Pre- versus postembolization MDs in VAS scores ranged from 32 within the first week to 58 after a 2-year follow-up (equivalent to 54% and 80% improvement, respectively). There was a similar trend in the overall WOMAC scores, with MDs ranging from 28.4 to 36.8 (about 58% and 85% improvement, respectively). GAE resulted in a decreased need for pain medication for knee OA, with a 27%, 65%, and 73% decline in the number of patients who used opioids, nonsteroidal anti-inflammatory drugs, and intra-articular hyaluronic acid injection, respectively ( P < .00001 for all). No significant difference between embolic agents was seen with regard to post-GAE pain reduction. No severe or life-threatening complications were reported. Conclusion: OA treated by GAE using different embolic particles can be considered generally safe, with good efficacy and no reported serious complications.

show abstract

“…To achieve this, there are 6 vessels that are typically targeted during GAE, which include the medial superior genicular artery, medial inferior genicular artery, lateral superior genicular artery, lateral inferior genicular artery, descending genicular artery, and anterior tibial recurrent artery (36)(37)(38)(39). Studies have demonstrated that all 6 arteries are present in most patients, with asymmetry in size between vessels and collateralization of supply across the joint being both been reported (36)(37)(38). The specific mechanism of action of GAE is to arrest the downstream effects of inflammation, which include the growth of unmyelinated sensory nerves in the articular and periarticular structures and the release of cytokine/neuropeptides that exaggerate response to pain stimuli.…”

Section: Gae (Anatomy and Mechanism Of Effect)mentioning

confidence: 99%

Percutaneous Management of Osteoarthritis in the Knee: Proceedings from the Society of Interventional Radiology Research Consensus Panel

Ahmed

Block

Mautner

et al. 2021

Journal of Vascular and Interventional Radiology

View full text Add to dashboard Cite

GAE ¼ genicular artery embolization, GNA ¼ genicular nerve ablation, NSAIDs ¼ nonsteroidal anti-inflammatory drugs, OA ¼ osteoarthritis, RCP ¼ research consensus panel, TKA ¼ total knee arthroplasty BACKGROUND Osteoarthritis (OA) of the knee is a complex, multifactorial disease with no known cure (1). Treatment options seek to manage symptoms, since no proven disease-modifying therapies currently exist. However, for many patients, adequate and sustained symptom control can be challenging to achieve. Depending on disease severity, various

show abstract

Clinical Outcomes of Transcatheter Arterial Embolisation for Chronic Knee Pain: Mild-to-Moderate Versus Severe Knee Osteoarthritis

Cited by 101 publications

References 26 publications

Genicular artEry embolizatioN in patiEnts with oSteoarthrItiS of the Knee (GENESIS) Using Permanent Microspheres: Interim Analysis

Genicular artEry embolizatioN in patiEnts with oSteoarthrItiS of the Knee (GENESIS) Using Permanent Microspheres: Interim Analysis

Osteoarthritis-Related Knee Pain Treated With Genicular Artery Embolization: A Systematic Review and Meta-analysis

Percutaneous Management of Osteoarthritis in the Knee: Proceedings from the Society of Interventional Radiology Research Consensus Panel

Contact Info

Product

Resources

About