Genicular Artery Embolization for Osteoarthritis Related Knee Pain: A Systematic Review and Qualitative Analysis of Clin
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REVIEW
EMBOLISATION (ARTERIAL)
Genicular Artery Embolization for Osteoarthritis Related Knee Pain: A Systematic Review and Qualitative Analysis of Clinical Outcomes Leigh C. Casadaban1 • Jacob C. Mandell1 • Yan Epelboym1
Received: 22 June 2020 / Accepted: 13 October 2020 Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Abstract Objective To systematically review the published literature on genicular artery embolization (GAE) for osteoarthritis (OA) related knee pain. Materials and Methods Using three databases, a systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Outcome measures included the Visual Analog Scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results Three single-arm studies were included from an initial search yielding 305 results. One hundred and eighty-six knees in 133 patients with either mild-to-moderate (174/186, 94%) or severe (12/ 186, 6%) OA underwent embolization with either imipenem/cilastatin sodium (159/186, 85%) or embozene (27/186, 15%). Technical success was 100%. Average VAS improved from baseline at 1 day, 1 week, 1 month, 3 months, 4 months, 6 months, 1 year and 2 years (66.5 at baseline vs 33.5, 32.7, 33.8, 28.9, 29.0, 22.3, 14.8 and 14.0, respectively). Average WOMAC scores improved from baseline at 1, 3, 4, 6, 12 and 24 months (45.7 at baseline vs 24.0, 31.0, 14.8, 14.6, 8.2 and 6.2). Severe OA in 12 cases showed initially improved VAS, but was not sustained. Minor adverse events such as erythema in the region of embolization (21/186, 11%), puncture-site hematoma (18/ 186, 10%), paresthesia (2/186, 1%) and fever (1/186, 0.5%) were reported. Conclusion Limited single-arm studies report GAE is promising for treating OA-related pain. Most
& Yan Epelboym [email protected] 1
Division of Angiography and Interventional Radiology, Department of Radiology, Brigham and Women’s Hospital, Boston, MA 02115, USA
treatments performed for mild-to-moderate OA demonstrated durable clinical responses from 6 months to 4 years. Limited data for severe OA suggest a non-durable response. Future studies should be standardized to facilitate comparison and control for placebo effect. Keywords Genicular artery embolization Interventional radiology Osteoarthritis
Introduction Symptomatic knee osteoarthritis (OA) affects more than 1 in 10 adults based on National Consensus data (NHANES III) and is a leading cause of disability [1, 2]. The cause of knee OA is multifactorial and pain can persist despite medical and surgical treatments [3, 4]. In conjunction with cartilage breakdown, literature suggests that chronic bone and synovial inflammation stimulates angiogenesis, hyperplasia and ongoing recruitment of inflammatory cells that leads to sensory nerve growth, which contributes to pain [5–8]. Okuno et al. first described treatment of angiographically abnormal vasculature
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