Repeated Genicular Artery Embolization Using Permanent Microspheres for Severe Osteoarthritis and Postsurgical Pain

Area of Science:

• Interventional Radiology
• Vascular Interventions
• Pain Management

Background:

• Severe osteoarthritis (OA) and persistent pain after total knee replacement (post-TKR) significantly impact patient quality of life.
• Genicular artery embolization (GAE) is an emerging treatment for knee pain, but reperfusion can limit its long-term efficacy.

Purpose of the Study:

• To investigate vessel reperfusion following initial genicular artery embolization (GAE) in patients with severe OA or post-TKR pain.
• To evaluate the clinical efficacy of repeat GAE (reGAE) in patients who did not achieve satisfactory improvement after the first GAE.

Main Methods:

• Prospective observational study involving patients with severe OA or post-TKR pain.
• GAE performed using permanent microspheres; clinical outcomes assessed using the numeric rating scale (NRS) up to 12 months.
• Repeat GAE (reGAE) offered to patients not achieving minimal clinically important difference (MCID) at 6 months; angiographic blush size compared before and after procedures.

Main Results:

• Initial GAE achieved MCID in 42% of patients; 36% additional responders after reGAE, with sustained efficacy.
• Significant increase in blush size in previously treated vessels observed at 6 months, indicating reperfusion and necessitating reGAE.
• Overall, 78% of patients achieved MCID after initial GAE and/or reGAE.

Conclusions:

• Reperfusion of genicular arteries occurs by 6 months in patients not responding to initial GAE.
• Repeat GAE is an effective additive treatment strategy, increasing the proportion of clinical responders for severe OA and post-TKR pain.
• GAE, including repeat procedures, offers a viable option for managing refractory knee pain.