Knee Osteoarthritis Embolization: A New Minimally Invasive and Natural Treatment for Pain palliation
What is Knee Osteoarthritis Embolization?
→ Principle
Knee osteoarthritis embolization is an innovative treatment for knee osteoarthritis flares. Knee osteoarthritis is a condition that progresses through flares, involving several types of lesions, including inflammation of the joint lining (called synovium). This inflammation, known as synovitis, is responsible for the pain and swelling during an osteoarthritis flare. It is linked to the abnormal development of small arteries. Embolization aims to block these overdeveloped small arteries to reduce the inflammation.
→ How it Works
Embolization involves inserting a catheter into a leg artery and navigating it to the knee arteries (called genicular arteries). Using imaging techniques, the abnormally developed arteries are identified and blocked. This process stops the hypervascularization, thus alleviating the symptoms.
→ Benefits of a New Minimally Invasive and Natural Treatment
The main advantage of this approach is its minimally invasive nature. Everything is done through a catheter inserted directly into a leg artery. The procedure is painless and is performed under local anesthesia. Furthermore, embolization is a natural treatment as the injected product to block the arteries dissipates within a few hours, leaving no trace. After 2 hours of monitoring, the patient can go home. The return to normal activities is almost immediate, and clinical improvement is generally felt a few days post-procedure.
How is the Knee Osteoarthritis Embolization Procedure Performed?
→ ENVIRONMENT
The procedure takes place in an operating room equipped with radiology machines. General anesthesia is not necessary; local anesthesia or conscious sedation is sufficient.
→ TECHNIQUE
After numbing the skin, the radiologist accesses an artery in the groin area. Using catheters and under radiological control, the radiologist navigates through the vessels to perform an arteriography, mapping the knee’s arterial network to identify hyperdeveloped arteries. These are then blocked with a product that dissipates quickly. At the end of the procedure, the catheters are removed, and the puncture site is covered with a bandage. This is the only small scar left by the procedure.
→ POST-OPERATIVE CARE
The patient is monitored for 1 hour in the recovery room before returning to their room. Hospital discharge can occur after 2 hours of monitoring, following the operator’s confirmation of no complications. The patient is then seen for a follow-up consultation 6 weeks after the procedure, along with control imaging.
Knee Osteoarthritis Embolization: Dr. Moulin’s Presentation at the Academy of Surgery in September 2024
What are the Results of Knee Osteoarthritis Embolization?
Embolization is a relatively recent treatment. The first cases were performed around ten years ago. New studies on the subject are published regularly, gradually increasing the level of evidence.
Results on Pain
A recent meta-analysis of the 9 largest studies on the subject showed an improvement in the VAS (Visual Analog Scale for pain from 0 to 10) by an average of 4 points, with a lasting effect 12 months after the procedure.
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Functional Results
The same meta-analysis showed an improvement of about 30 points out of 100 in functional scores, particularly the WOMAC score.
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Long-Term Results
Studies show a prolonged effect up to 2 years in about 70% of patients. As knee osteoarthritis embolization is a relatively recent procedure, it is still difficult to determine long-term outcomes.
Specialist Doctors at the Institute for Knee Osteoarthritis Embolization
Knee Osteoarthritis Treatment by Genicular Artery Embolization: What Are the Side Effects?
The risk of major complications following genicular artery embolization is practically zero, less than 0.5%. Minor complications may occur, with some local pain related to the occlusion of distal arteries. These pains are usually treated with simple medication like paracetamol and subside a few days after the procedure.
Knee Osteoarthritis Embolization: FREQUENTLY ASKED QUESTIONS
Are exams necessary before embolization?
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Is an exam necessary before knee osteoarthritis embolization? Usually, the diagnosis is made during the clinical interview and physical examination, as well as knee X-rays (front, side, and weight-bearing). An ultrasound can confirm hypervascularization, but it is generally the MRI that confirms the presence of inflammatory synovitis and provides information on the degree of osteoarthritis (such as the state of the cartilage).
What are the indications for embolization?
What are the indications for knee osteoarthritis embolization? Patients who may benefit from embolization are those with moderate to severe knee osteoarthritis, persisting for at least 6 months, and resistant to well-conducted medical treatment combining physical measures (rehabilitation), lifestyle adjustments, and possibly corticosteroid injections. Radiological stages (Kellgren-Lawrence classification) grade 1 to 3 can be treated by embolization.
Are there any contraindications for embolization?
Are there any contraindications for pelvic congestion syndrome embolization? The only absolute contraindication for genicular artery embolization is lower limb artery disease (blocked or narrowed arteries). If there is a risk factor for artery disease (diabetes, smoking, or other), an echo-doppler of the lower limbs is performed before the procedure. Additionally, patients with severe osteoarthritis (Kellgren-Lawrence radiographic stage 4) often have poorer results, and in such cases, surgical treatment, such as a knee replacement, is preferable. Moreover, not all knee pain is necessarily caused by osteoarthritis. MRI often provides a good diagnostic orientation, and it is the correlation between MRI images and clinical presentation that best guides patient management.
What are the risks and side effects of embolization?
What are the risks and side effects of knee osteoarthritis embolization? The first two days after the procedure may involve slight local discomfort, which subsides after taking simple painkillers (paracetamol). More serious complications (hemorrhage, infection) are rare with modern guidance methods (ultrasound-guided puncture, fluoroscopy-guided embolization).
Are there any precautions to take after embolization?
Are there any precautions to take after knee osteoarthritis embolization? What is the recovery like? No specific precautions are required after knee osteoarthritis embolization. Sports and lifting heavy objects can be resumed 48 hours later if no complications occur.
What to do if there are problems after the procedure?
What to do if there are problems after the procedure? The IF-RI Institute has an on-call service with a doctor available 24/7. Usually, the radiologist who performed the embolization will also provide their contact information.
Is embolization effective in the long term?
Is knee osteoarthritis embolization effective in the long term? Genicular artery embolization is a relatively new treatment. Studies show a lasting improvement for up to 2 years. Beyond 2 years, there are currently no data on its effectiveness. Studies are ongoing, and results will be communicated as soon as they become available.
What is the cost of embolization? Is it covered by insurance?
What is the cost of knee osteoarthritis embolization? Is it covered by social security? Embolization is covered by social security. Our radiologists usually charge moderate fees, allowing for patient care. The patient’s out-of-pocket expenses depend on their insurance coverage but generally range from 0 to a few hundred euros.
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