transcatheter arterial embolization in patients with mild to moderate osteoarthritis

Conditions: Osteoarthritis, Knee

Summary: disabling symptoms of osteoarthritis are seen in approximatively 10% of people over 55 years old. many patients suffer from persistent pain symptoms from moderate osteoarthritis despite optimal medical treatment. for these patients, several minimally-invasive surgical treatments have been proposed, including arthroscopic lavage and debridement; however, none of these treatments have been proven effective compared to sham treatment. recently, catheter-directed embolotherapy of the geniculate arteries has been propagated as a real alternative to medical management in patients with mild to moderate knee osteoarthritis unresponsive to conservative medical management.

disabling symptoms of osteoarthritis are seen in approximatively 10% of people over 55 years old. traditionally, treatment of symptomatic knee osteoarthritis is based on administration of pain relievers, including nonsteroidal anti-inflammatory drugs, in case of mild to moderate symptoms; major joint replacement surgery (total joint arthroplasty) is performed in cases of severe and end-stage osteoarthritis. however, many patients suffer from persistent pain symptoms from moderate osteoarthritis despite optimal medical treatment. for these patients, several minimally-invasive surgical treatments have been proposed, including arthroscopic lavage and debridement; however, none of these treatments have been proven effective compared to sham treatment. recently, catheter-directed embolotherapy of the geniculate arteries has been propagated as a real alternative to medical management in patients with mild to moderate knee osteoarthritis unresponsive to conservative medical management. transcatheter embolotherapy was performed using imipenem/cilastin sodium or 75 micron calibrated embozene microspheres and follow-up was performed by physical examination, questionnaires (vas-score and womac-scores) and mr-imaging (worms-score). results of these trials confirmed that catheter-directed embolotherapy is a safe procedure without any major adverse events. womac pain scores dropped dramatically from 12.2 +/- 1.9 before the procedure to 3.3 +/- 2.1 at 1 month after the procedure and to 1.7 +/- 2.2 at 4 months after the procedure. additionally, mr imaging at 2 years of follow-up could not demonstrate any osteonecrosis or progression of degenerative changes.

Eligibility criteria:
inclusion criteria: * presence of knee pain * kellgren-lawrence (kl) grade 1-3 assessed by weight-bearing knee radiographs * local tenderness around the knee * clinical failure after 3 months or more of conservative therapies, including oral nonsteroidal anti-inflammatory drugs and/or oral opioid agents and physical therapy, stretching, muscle strengthening and/or intra-articular injection of hyaluronic acid * persistent moderate to severe knee pain (vas \> 50 mm) for more than 3 months * patient is able to give consent exclusion criteria: * previous knee surgery * local infection * bmi \> 40 kg/m2 * advanced atherosclerosis * rheumatoid arthritis, malignancy, renal insufficiency, other conditions contra-indicating femoropopliteal angiography * usage of anticoagulants such as eliquis or coumarine (asaflow allowed) * allergy to iodinated contrast medium or any other allergy

Keywords: osteoarthritis catheter-directed embolotherapy poly-vinyl alcohol microspheres