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

To investigate reperfusion after genicular artery embolization (GAE) in patients with severe osteoarthritis (OA) or persistent pain after total knee replacement (post-TKR), who did not achieve clinical improvement after initial GAE, and to evaluate the clinical efficacy of repeat GAE (reGAE).

This prospective observational study included patients with radiographically severe OA or post-TKR pain. GAE was performed using permanent microspheres. Clinical outcome was assessed at 6 weeks, 3, 6, 9, and 12 months using the numeric rating scale (NRS). Minimal clinically important difference (MCID) was defined as an improvement of at least 2 points compared with baseline. Patients failing to achieve MCID at 6 months underwent reGAE. Angiographic blush size before and after embolization during GAE and reGAE was measured and compared.

In 55 patients (87 GAEs), a median of 4 (range, 2-6) vessels was treated, with a median total embolic volume of 4.5 mL (1.5-10.1 mL). After initial GAE, 23 patients (42%) achieved MCID. Following reGAE at 6 months, an additional 20 patients (36%) reached MCID, with sustained efficacy up to 6 months after reGAE (p ≤ 0.0001); 12 patients (22%) remained non-responders. Quantitative angiographic analysis demonstrated a significant increase in blush size within previously treated vessels, necessitating reGAE (p ≤ 0.0001).

After GAE using permanent microspheres, reperfusion of previously treated vessels was observed at 6 months in all patients failing to achieve MCID. ReGAE increased the proportion of clinical responders, supporting its role as an effective additive treatment strategy in severe OA and post-TKR pain.