Abstract
PurposePlanned 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.MethodsThirty-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.ResultsTechnical 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.ConclusionGAE using permanent microspheres in patients with mild to moderate knee OA is safe, with potential efficacy at early follow-up.
Highlights
Osteoarthritis (OA) of the knee joint is the most common articular disease of the developed world, and a leading cause of chronic disability, and economic burden [1]
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
Mean visual analogue scale (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)
Summary
Osteoarthritis (OA) of the knee joint is the most common articular disease of the developed world, and a leading cause of chronic disability, and economic burden [1]. Physiotherapy, intraarticular steroid, platelet-rich plasma (PRP), or hyaluronic injections, education programs, weight loss, and anti-inflammatory preparations. Joint replacement surgery is generally reserved for those with severe joint disease, pain, and functional limitation [2]. Expectations of surgery are not met in up to 30% of patients undergoing total knee replacement (TKR) [3]. Mild to moderate knee OA, not yet severe enough to warrant joint replacement, and resistant to nonsurgical options, represents a specific management challenge that justifies research into the area. Little et al.: Genicular artEry embolisatioN in patiEnts with oSteoarthrItiS of the Knee
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