Genicular Artery Embolization for the Treatment of Persistent Knee Pain Following Joint Replacement Surgery

Chronic pain following total knee arthroplasty (TKA) for osteoarthritis (OA) occurs in ~20% of patients {1}. Persistent pain leads to reduced mobility, decreased functionality, increased analgesic usage, and poor quality of life {1}. Genicular artery embolization (GAE) is a transarterial catheter-based therapy targeting chronically inflamed synovium by embolizing hypervascular feeding vessels to decrease inflammation and provide symptomatic relief {2}. GAE is proving efficacious in hemarthrosis and osteoarthritis {3}. This study analyzes the efficacy of GAE in improving pain and quality of life, increasing functionality and mobility, and reducing analgesic use in post-TKA patients with chronic pain. 


Materials and Methods:

We present early results of a single-arm pilot trial of 10 patients post-TKA for OA with chronic pain. Patients are evaluated pre-GAE, and 2 weeks, 1 month, 3 months, and 6 months post-GAE. Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short Form-36 (SF-36), Knee injury and Osteoarthritis Outcome Score (KOOS), and pain medication logs will be used to assess pain, functionality, and quality of life pre- and post-GAE. Patients undergo diagnostic imaging of affected knee(s) pre-treatment and 3 and 6 months post-GAE. 



Results:

Early results demonstrate decreased pain sustained across a 3 to 6 month period post-GAE. KOOS outcomes show a steady uptrend in function in activities of daily living (86.9% increase) and sports and recreation (122.2% increase) over a 3 to 6 month period, while WOMAC scores decreased over the same period (45.7% decrease). SF-36 scores exhibit a consistent increase in daily physical functioning over the study period (140% increase). Data collection and patient recruitment is ongoing.       



Conclusion:

Preliminary results suggest both functional and subjective benefit after GAE for patients with chronic pain post-TKA. Overall trends demonstrate decreased pain and increased functionality in multiple aspects of daily life. These promising results indicate that GAE in post-TKA patients may offer an efficacious, minimally-invasive intervention for a previously under-treated and challenging patient population.