Skip to main content

Advertisement

SpringerLink
Log in

Genicular artery embolization as a treatment for refractory osteoarthritis related knee pain

  • Review Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Genicular artery embolization (GAE) is a minimally invasive outpatient therapy for osteoarthritis (OA) related knee pain, refractory to conservative management. This intervention targets neovasculature which arises in the setting of angiogenesis in OA. Various clinical trials highlighted in this manuscript suggest that GAE is effective in durably reducing OA-related knee pain, with a limited adverse event profile. This review also explores the clinical evaluation of GAE candidates, genicular artery anatomy, technical components of the procedure, and imaging from various GAE embolizations. It also discusses future directions for research which may illuminate predictors of clinical success as well as avenues for evolution in the GAE treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15

Similar content being viewed by others

References

  1. Lane NE, Brandt K, Hawker G, et al. OARSI-FDA initiative: defining the disease state of osteoarthritis. Osteoarthr Cartil. 2011;19(5):478–82.

    Article  CAS  Google Scholar 

  2. Sellam J, Berenbaum F. The role of synovitis in pathophysiology and clinical symptoms of osteoarthritis. Nat Rev Rheumatol. 2010;6(11):625–35.

    Article  CAS  PubMed  Google Scholar 

  3. Ashraf S, Mapp PI, Walsh DA. Contributions of angiogenesis to inflammation, joint damage, and pain in a rat model of osteoar- thritis. Arthritis Rheum. 2011;63(09):2700–10.

    Article  CAS  PubMed  Google Scholar 

  4. Ashraf S, Wibberley H, Mapp PI, Hill R, Wilson D, Walsh DA. Increased vascular penetration and nerve growth in the meniscus: a potential source of pain in osteoarthritis. Ann Rheum Dis. 2011;70(3):523–9.

    Article  PubMed  Google Scholar 

  5. Mapp PI, Walsh DA. Mechanisms and targets of angiogenesis and nerve growth in osteoarthritis. Nat Rev Rheumatol. 2012;8(07):390–8.

    Article  CAS  PubMed  Google Scholar 

  6. Bannuru RR, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthr Cartil. 2014;22:363–88.

    Article  Google Scholar 

  7. Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, Kraus VB, Lohmander LS, Abbott JH, Bhandari M, Blanco FJ, Espinosa R, Haugen IK, Lin J, Mandl LA, Moilanen E, Nakamura N, Snyder-Mackler L, Trojian T, Underwood M, McAlindon TE. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthr Cartil. 2019;27(11):1578–89.

    Article  CAS  Google Scholar 

  8. Okuno Y, et al. Transcatheter arterial embolization as a treatment for medial knee pain in patients with mild to moderate osteoarthritis. Cardiovasc Intervent Radiol. 2015;38(2):336–43 (15).

    Article  PubMed  Google Scholar 

  9. Okuno Y, Korchi AM, Shinjo T, Kato S, Kaneko T, et al. Midterm clinical outcomes and MR imaging changes after transcatheter arterial embolization as a treatment for mild to moderate radiographic knee osteoarthritis resistant to conservative treatment. J Vasc Interv Radiol. 2017;28(7):995–1002.

    Article  PubMed  Google Scholar 

  10. Lee SH, et al. Clinical outcomes of transcatheter arterial embolisation for chronic knee pain: mild-to-moderate versus severe knee osteoarthritis. Cardiovasc Intervent Radiol. 2019;42(11):1530–6.

    Article  PubMed  Google Scholar 

  11. Padia SA, Genshaft S, Blumstein G, Plotnik A, Kim GHJ, Gilbert SJ, Lauko K, Stavrakis AI. Genicular artery embolization for the treatment of symptomatic knee osteoarthritis. JB JS Open Access. 2021;6(4):e21.00085.

    PubMed  PubMed Central  Google Scholar 

  12. Bagla S, et al. Genicular artery embolization for the treatment of knee pain secondary to osteoarthritis. J Vasc Interv Radiol. 2019;31:1096.

    Article  PubMed  Google Scholar 

  13. Bagla S, Piechowiak R, Sajan A, Orlando J, Hartman T, Isaacson A. Multicenter randomized Sham controlled study of genicular artery embolization for knee pain secondary to osteoarthritis. J Vasc Interv Radiol. 2022;33(1):2-10.e2.

    Article  PubMed  Google Scholar 

  14. Landers S, Hely R, Page R, Maister N, Hely A, Harrison B, Gill S. Genicular artery embolization to improve pain and function in early-stage knee osteoarthritis-24-month pilot study results. J Vasc Interv Radiol. 2020;31(9):1453–8.

    Article  PubMed  Google Scholar 

  15. Little MW, Gibson M, Briggs J, Speirs A, Yoong P, Ariyanayagam T, Davies N, Tayton E, Tavares S, MacGill S, McLaren C, Harrison R. Genicular artEry embolizatioN in patiEnts with oSteoarthrItiS of the Knee (GENESIS) using permanent microspheres: interim analysis. Cardiovasc Intervent Radiol. 2021;44(6):931–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Cornman-Homonoff J, Kishore SA, Waddell BS, Kesler J, Mandl LA, Westrich GH, Potter HG, Trost DW. Genicular artery embolization for refractory hemarthrosis following total knee arthroplasty: technique, safety, efficacy, and patient-reported outcomes. J Vasc Interv Radiol. 2021;32(8):1128–35.

    Article  PubMed  Google Scholar 

  17. Dillon CF, Rasch EK, Gu Q, Hirsch R. Prevalence of knee osteoarthritis in the United States: arthritis data from the Third National Health and Nutrition Examination Survey 1991–94. J Rheumatol. 2006;33:2271.

    PubMed  Google Scholar 

  18. Ma VY, Chan L, Carruthers KJ. Incidence, prevalence, costs, and impact on disability of common conditions requiring rehabilitation in the united states: Stroke, spinal cord injury, traumatic brain injury, multiple sclerosis, osteoarthritis, rheumatoid arthritis, limb loss, and back pa. Arch Phys Med Rehabil. 2014;95:986.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Peat G, McCarney R, Croft P. Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Ann Rheum Dis. 2001;60:91–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Institute of Medicine of the National Academies. Relieving pain in America: a blueprint for transforming prevention, care, education, and research. Washington, DC: National Academies Press; 2011.

    Google Scholar 

  21. Kompel AJ, Roemer FW, Murakami AM, Diaz LE, Crema MD, Guermazi A. Intra-articular corticosteroid injections in the hip and knee: perhaps not as safe as we thought? Radiology. 2019;293(3):656–63.

    Article  PubMed  Google Scholar 

  22. Sighary M, Sajan A, Walsh J, Márquez S. Cadaveric classification of the genicular arteries, with implications for the interventional radiologist. J Vasc Interv Radiol. 2022;33(4):437-444.e1.

    Article  PubMed  Google Scholar 

  23. Sajan A, Mehta T, Griepp DW, Chait AR, Isaacson A, Bagla S. Comparison of minimally invasive procedures to treat knee pain secondary to osteoarthritis: a systematic review and meta-analysis. J Vasc Interv Radiol. 2022;33(3):238-248.e4. https://doi.org/10.1016/j.jvir.2021.11.004.

    Article  PubMed  Google Scholar 

  24. O’Grady A, Welsh L, Gibson M, Briggs J, Speirs A, Little M. Cadaveric and angiographic anatomical considerations in the genicular arterial system: implications for genicular artery embolisation in patients with knee osteoarthritis. Cardiovasc Intervent Radiol. 2022;45(1):80–90.

    Article  PubMed  Google Scholar 

  25. Torkian P, Golzarian J, Chalian M, Clayton A, Rahimi-Dehgolan S, Tabibian E, Talaie R. Osteoarthritis-related knee pain treated with genicular artery embolization: a systematic review and meta-analysis. Orthop J Sports Med. 2021;9(7):232596712110213.

    Article  Google Scholar 

  26. Ahmed O, Block J, Mautner K, Plancher K, Anitescu M, Isaacson A, Filippiadis DK, Epelboym Y, Bercu Z, Mitchell JW, Cristescu M, White SB, Prologo JD. Percutaneous management of osteoarthritis in the knee: proceedings from the Society of Interventional Radiology Research Consensus Panel. J Vasc Interv Radiol. 2021;32(6):919.e1-919.e6.

    Article  PubMed  Google Scholar 

  27. Choi JW, Ro DH, Chae HD, Kim DH, Lee M, Hur S, Kim HC, Jae HJ, Chung JW. The value of preprocedural MR imaging in genicular artery embolization for patients with osteoarthritic knee pain. J Vasc Interv Radiol. 2020;31(12):2043–50.

    Article  PubMed  Google Scholar 

  28. Gunaratne R, Pratt DN, Banda J, Fick DP, Khan RJK, Robertson BW. Patient dissatisfaction following total knee arthroplasty: a systematic review of the literature. J Arthroplasty. 2017;32(12):3854–60.

    Article  PubMed  Google Scholar 

  29. van Zadelhoff TA, Okuno Y, Bos PK, Bierma-Zeinstra SMA, Krestin GP, Moelker A, Oei EHG. Association between baseline osteoarthritic features on MR imaging and clinical outcome after genicular artery embolization for knee osteoarthritis. J Vasc Interv Radiol. 2021;32(4):497–503.

    Article  PubMed  Google Scholar 

  30. Riis RG, Gudbergsen H, Henriksen M, et al. Synovitis assessed on static and dynamic contrast-enhanced magnetic resonance imaging and its association with pain in knee osteoarthritis: a cross-sectional study. Eur J Radiol. 2016;85:1099–108.

    Article  PubMed  Google Scholar 

  31. Riis RG, Gudbergsen H, Simonsen O, et al. The association between histological, macroscopic and magnetic resonance imaging assessed synovitis in end-stage knee osteoarthritis: a cross-sectional study. Oste- oarthritis Cartilage. 2017;25:272–80.

    Article  CAS  Google Scholar 

  32. Ballegaard C, Riis RG, Bliddal H, et al. Knee pain and inflammation in the infrapatellar fat pad estimated by conventional and dynamic contrast-enhanced magnetic resonance imaging in obese patients with osteoarthritis: a cross-sectional study. Osteoarthr Cartil. 2014;22:933–40.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Division of Angiography and Interventional Radiology, Brigham & Women’s Hospital, Harvard Medical School, Boston, USA

    Yan Epelboym

  2. Department of Radiology, University of California, Los Angeles, Los Angeles, USA

    Lynden Lee

  3. Musculoskeletal Intervention Center, Okuno Clinic, 4th Fl Ginrei Bldg, 7-8-4 Minato-ku, Roppongi, Tokyo, 106-0032, Japan

    Yuji Okuno

  4. Imaging Center Onex, Geneva, Switzerland

    Amine Korchi

Authors
  1. Yan Epelboym
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lynden Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yuji Okuno
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Amine Korchi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yan Epelboym.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Highlights

• GAE is a superselective embolization of joint neovascularity in patients with OA and angiogenesis.

• Clinical trials suggest that GAE is safe and effective in treating OA-related knee pain refractory to conservative management.

• An understanding of genicular artery anatomy, technique, and literature is critical for optimizing outcomes and appropriately managing patient expectations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Epelboym, Y., Lee, L., Okuno, Y. et al. Genicular artery embolization as a treatment for refractory osteoarthritis related knee pain. Skeletal Radiol 52, 2309–2321 (2023). https://doi.org/10.1007/s00256-022-04208-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-022-04208-0

Keywords

Search

Navigation