Treatment of osteoarthritis of the knee without surgery: genicular artery embolization

Knee or genicular artery embolization (GEA) is a new minimally invasive and painless procedure that relieves pain and improves functional limitation resulting from osteoarthritis immediately and in the long term. GSD can delay or prevent the need for knee replacement, and improves mobility in patients with established knee osteoarthritis. The procedure also reduces knee swelling to improve function and quality of life for people with moderate to severe pain.

The main indications are for the symptomatic treatment of mild to moderate osteoarthritis of the knee that does not respond to more conservative measures, treatment of recurrent hemarthrosis of the knee, and symptomatic treatment of osteoarthritis following knee replacement.

What does the procedure consist of?

The intervention consists of catheterizing the knee arteries by injecting tiny particles into the arteries leading to the knee in order to reduce blood flow in the areas where inflammatory phenomena occur as a consequence of osteoarthritis, thus reducing inflammation.

The procedure, which is performed on an outpatient basis and with a virtually non-existent rate of complications, is performed by an interventional radiologist, a specialist who uses X-rays and other imaging modalities to view the body and treat diseases without surgery. During the procedure, the arteries of the knee are catheterized with thin tubes or catheters and the arteries that perpetuate the inflammatory process causing pain are embolized or plugged. The GSD is performed under minimal sedation and lasts approximately one to two hours. At the end of the process the patient is discharged with minimal analgesia.

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How effective is it?

Studies show high efficacy in patients with debilitating knee pain who are not candidates for or are unwilling to undergo knee replacement surgery (prosthesis). While it may not treat the underlying cartilage destruction, the evidence so far shows that it can be an effective way to control symptoms.

GSD is a non-surgical treatment alternative for patients with knee pain and/or limitation secondary to osteoarthritis who have failed conservative therapy, such as anti-inflammatory medications or knee injections, and who do not wish to undergo knee replacement surgery or are not candidates for it. Patients with recurrent hemarthrosis or pain after knee replacement are also good candidates for GSD.

When is it recommended?

The profile of the patient candidate for a GSD in the context of established osteoarthritis:

  • Age: 40-80 years.
  • Moderate to severe knee pain.
  • Osteoarthritis objectified on X-ray, although an MRI is advisable to rule out other causes of joint pain.
  • Local knee pain.
  • Resistance or failure to conservative treatment (non-steroidal anti-inflammatory drugs (NSAIDs)/TP/joint injection).

GSD may not be indicated in:

  • Very severe arteriopathy.
  • Very advanced osteoarthritis (RX).
  • Infection or malignancy.
  • Good candidate for knee replacement surgery.