Geniculate Artery Embolization as a Treatment for Persistent Knee Pain in Osteoarthritis Patients after Total Knee Replacement
Department of Radiology, Shaare Zedek Medical Center, Israel
PURPOSE: To descibe safety and efficacy of geniculate artery embolization (GAE) as a treatment option for persistent pain after total knee replacment (TKA). To describe the unique arterial anatomy of the knee joint.
It is now generally accepted that OA is not simply a "wear-and-tear" disease, but a low-grade inflammatory disease of synovial joints. Angiogenesis is thought to contribute to the beginning and more importantly, the maintenance of inflammation. Moreover, aniogenenesis may contribute to chronic pain by enabling growth of new sensory nerve fibers. It is on this basis, that Okuno et al. (JVIR, July 2017) recently described embolization of geniculate arteries as a treatment option for mild to moderate radiographic knee OA resistant to conservative treatment.
About 20% of patient who undergo TKA suffer persistent pain after surgery, without clear etiology. We hypothesize that angiogenesis may play a similar role in persistent knee pain after TKA, and that GAE may be similarly effective in effecting pain relief.
MATERIALS AND METHODS: One 84-year-old male who is 2-years post total knee arthroplasty with persistent knee pain, was treated with GAE in the branches supplying the anterior joint, his reported area of persistent pain. At angiography, several anterior geniculate artery branches demonstrated characteristic hypervascular "blush" of angiogenesis; these were targeted for superselective embolization with 100 micron microsphere particles.
RESULTS: At 1-week follow up phone consultation, the patient reported significant improvement in pain and mobility of the joint. He is currently without need for daily pain medications for the first time in 2 years. No major or minor complications were noted.
CONCLUSION: GAE is a promising new treatment option for TKA patients with persistent knee pain after surgery.