Geniculate Artery Embolization for Knee Osteoarthritis

A prospective cohort study to study the effectiveness and safety profile of geniculate artery embolization for the treatment of symptomatic knee osteoarthritis.

Purpose: The investigators aim to determine whether geniculate artery embolization is a safe treatment for symptomatic knee osteoarthritis and confirm published reports of sustained post-procedural pain relief, improved physical function and investigate potential improvements in joint function quantitatively through imaging and targeted assessments.

Participants:Twenty patients with moderate to severe knee pain, pain refractory for 3 months of conservative therapies, imaging features of symptomatic osteoarthritis and ineligible for arthroplasty for 1 year.

Procedures (methods): Patients will undergo a brief clinical evaluation to verify eligibility through inclusion and exclusion criteria in addition to a comprehensive joint pain treatment history will be recorded including active analgesic and anti-inflammatory use. A pre-procedural MRI will be completed to assess the extent of their osteoarthritis, signs of active synovitis and vascular anatomy of the knee. Evaluations post geniculate artery embolization will occur at 24 hours, 1, 6 and 12 months to assess for changes in knee pain and joint function and monitor adverse events. An MRI will be performed at the 6 month visit to detect changes in synovitis and exclude complications.

Eligibility Criteria:
Inclusion Criteria:

* Moderate to severe knee pain (visual analog scale (VAS) \> 50 mm), and
* Pain refractory for at least 3 months of conservative therapies (anti-inflammatory drugs, physical therapy, muscle strengthening or intra-articular injections), and
* Kellgren-Lawrence grade 1, 2 or 3 on knee radiograph, and
* MRI features of active synovitis (Synovial thickening and/or enhancement on MRI using pre-gadolinium sagittal T2-weighted/proton-density sequences and post-gadolinium T1 weighted imaging, respectively), and
* Willing, able and mentally competent to provide written informed consent (to ensure that all study subjects demonstrate an understanding of the risks of the procedure and participate in the informed consent), and
* Not eligible for surgical arthroplasty within 1 year of estimated procedure date

Exclusion Criteria:

* Major surgery within the past six weeks (excluding arthroscopic/meniscal interventions), or
* Ipsilateral knee intra-articular injection in the last 3 months, or
* Pregnant or attempting to become pregnant during study period, or
* Current local infection, or
* Life expectancy less than 6 months, or
* Known advanced atherosclerosis, or
* Rheumatoid or seronegative arthropathies, or
* Infectious arthritis, or
* Prior knee surgery (excluding arthroscopic/meniscal interventions), or
* Uncorrectable coagulopathy including international normalized ratio (INR) \> 1.5 or platelets \< 50,000, or
* Iodinated contrast allergy resulting in anaphylaxis, or
* Inability to lay supine on an angiographic table \>500 lbs due to table weight limits, or
* Renal dysfunction as defined as glomerular filtration rate \< 30 mL/min/1.73m2 obtained within the past 30 days, or
* Patients with documented noncompliance with previous medical care, or
* Patients with certain psychiatric disorders such as schizophrenia, borderline personality disorder, uncontrolled depression, or mental/cognitive impairment that limits the individual's ability to understand the proposed therapy, or
* Absence of synovitis on MRI