Geniculate Artery Embolization for Knee Osteoarthritis
Condition: Knee Osteoarthritis
MeSH terms: Osteoarthritis; Osteoarthritis, Knee
Study type: Interventional

Summary: 
      The purpose of this study is to perform a prospective case series to determine efficacy of
      transcatheter arterial embolization in treating knee osteoarthritis related pain, improving
      functionality, and reducing opiate usage in patients with mild to moderate knee
      osteoarthritis who have failed conservative management.

      The Gel-Bead embolization particles will be used to perform geniculate artery embolization
      (GAE) for the purposes of treatment of osteoarthritis-related knee pain.
    

Detailed description: 
      Management of mild and moderate knee osteoarthritis is curated to each specific patient and
      their needs, their quality of life, and desired goals. Weight loss is advised for overweight
      and obese patients. All patients should attempt extended-duration exercise/physical therapy
      and realignment therapy. If these conservative lifestyle modifications fail to reduce pain,
      topical and oral non-steroidal anti-inflammatories are indicated. Escalation of care from
      here is controversial. Some clinicians opt for adjunctive treatments such as intra-articular
      injection of steroids or viscosupplementation. Unfortunately, pain alleviation from
      intra-articular steroids is short-lasting and a recent meta-analysis demonstrated no
      significant difference between intra-articular hyaluronic acid injection and placebo
      injection. Finally, weak opioids are an option for patients who continue to have pain despite
      all the aforementioned treatment measures. Joint replacement is reserved for patients with
      severe osteoarthritis.

      Patients who fail conservative, medical management pose a challenge to clinicians. For
      decades, there have been no interventions available to these patients between the
      controversial intra-articular hyaluronic acid injection and joint replacement. Interventional
      radiology (IR) may provide one possible solution. Geniculate artery embolization (GAE) is a
      minimally-invasive procedure that has historically been performed for patients with recurrent
      hemarthrosis. It was recently applied to patients with moderate osteoarthritis refractory to
      maximal medical management. Several studies have been performed and have found that GAE is
      safe and improves pain.
    

Intervention name(s): Gel-Bead embolization
Intervention type(s): Device
Intervention description(s): OptiSphere is FDA approved for the embolization of hypervascular tumors. The product is crosslinked with glutaraldehyde, which improves the mechanical strength of the spheres and provides controlled degradation after implant. The spherical shape provides smooth embolic delivery and even, predictable distribution. In this study the Optispheres will be used for Geniculate artery embolization (GAE) which is a minimally-invasive procedure that has historically been performed for treatment of patients with recurrent knee hemarthrosis. Embolization is a procedure in which material is used to block small blood vessels. Angiogenesis, or growth of new vessels, has been implicated in the initiation and maintenance of joint inflammation. GAE has been applied to patients with moderate osteoarthritis-related pain refractory to maximal medical management with preliminary studies demonstrating a reduction in patient pain.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment