Osteoarthritis of the knee poses an ever-expanding healthcare challenge worldwide.
Current treatments include conservative methods such as weight loss, pharmacological
treatments including NSAIDs, and surgical techniques including total knee arthroplasty.
Although frequently successful, contraindications and failure of pharmacological agents
leave many, especially with mild-moderate disease, without effective treatment. Genicular
artery embolization is an interventional radiology technique being developed to fill
this treatment gap. For this procedure to become established, the literature must
provide evidence of its underlying scientific principles, safety, efficacy and economic
viability. Pathological investigation of osteoarthritis reveals that low-level inflammation
plays a crucial role in disease development. Joint inflammation stimulates neoangiogenesis
and accompanying neuronal growth, with the degree of microvascular invasion being
correlated with more severe pain in animal models. These neovessels provide a target
for embolization however, the microscopic effects of this intervention are yet to
be elucidated. The side effects of GAE have been extensively investigated with no
severe adverse events being recorded. Skin discoloration and puncture site hematoma
are the most common, occurring in 10%-65% and 0%-17% of patients respectively. The
literature also discusses ways to minimize these events. Phase one studies provide
promising evidence of efficacy, demonstrating an 80% improvement in Visual Analogue
Scale (VAS) and a mean difference of 36.8 in Western Ontario and McMaster Universities
Arthritis Index (WOMAC) scores at 24-months. These positive signals are also supported
by a single randomized control trial. A single study has been completed regarding
the cost of GAE, however further work is needed. The GAE literature demonstrates a
safe procedure with promising initial evidence of efficacy. Future work should further
elucidate the pathology of osteoarthritis and ways in which embolization modifies
this process, alongside providing further randomized control evidence that aligns
with the recommendations from the National Institute for Health and Care Excellence.
The future of GAE is exciting!
Keywords
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Article info
Publication history
Published online: December 21, 2022
Publication stage
In Press Corrected ProofFootnotes
Conflict of Interest: Consultant for Crannmed, Boston Scientific, Merit Medical, and Guerbet. Research funding from Varian. (Author: please confirm complete and correct)
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