Genicular Artery Embolization (GAE) for the Treatment of Advanced Knee Osteoarthritis in Selected Nonoperative Patients: A Pilot Study at 6 Months Follow-Up.

Background

Genicular Artery Embolization (GAE) is an emerging minimally invasive procedure for the treatment of pain due to knee osteoarthritis (OA) in patients who are not candidates for joint replacement surgery. The aim of this study is to evaluate the clinical and functional outcomes of GAE performed with a temporary embolic agent and the persistence of its benefits up to 6 months of follow-up.

Methods

In this prospective study, 15 consecutive patients (mean age 64.5 ± 6.7 years) with Kellgren-Lawrence grade III-IV knee OA, severe pain refractory to conservative treatments, and not eligible for joint replacement surgery were enrolled. All patients underwent GAE with selective embolization of hypervascular genicular branches using an imipenem/cilastatin suspension as a temporary embolic agent. Patients were evaluated before the procedure, on the first postoperative day, and at 3 and 6 months of follow-up using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Oxford Knee Score (OKS), and the Visual Analog Scale (VAS).

Results

All clinical scores showed a significant improvement over time (p < 0.05). WOMAC decreased from 55.6 ± 7.3 to 16.3 ± 4.1 at 6 months; KOOS increased from 40.7 ± 8.1 to 70.3 ± 6.4; OKS improved from 18.4 ± 4.2 to 38.9 ± 4.6; VAS decreased from 7.8 ± 1.0 to 1.5 ± 0.8. No major complications were observed. Two patients (13.3%) developed a subcutaneous hematoma at the femoral access site, which resolved spontaneously. In two patients, pain recurred at the 1-month follow-up.

Conclusions

GAE with a temporary embolic agent appeared to be a safe and effective procedure in improving pain and function in patients with advanced knee OA who are not candidates for joint replacement surgery. The clinical benefit was progressive and sustained up to 6 months, supporting the role of synovitis modulation as a therapeutic target.