Genicular artery embolisation for the management of knee osteoarthritis: a prospective randomised study

The aim of this study is to evaluate the efficacy of genicular artery embolisation (GAE) in improving pain and functional outcomes in patients with symptomatic knee osteoarthritis (KOA).

Fifty patients with KOA cases (Kellgren-Lawrence grade 2-4) were enrolled in a prospective, parallel arm, randomised study. The control arm received standard care, while the interventional arm received a single session of GAE with polyvinyl alcohol (PVA) particles, in addition. Visual analogue scale (VAS) and Knee Injury and Osteoarthritis Outcome Score (KOOS) scores were compared at baseline, at 1 week, 1, 3, 6, and 12 months.

GAE was planned for 29 knees in 25 participants. Technical success was 82.8% (24/29 knees), with 92 arteries embolised in 28 knees (mean 3.32 ± 1.12). At 1 year, VAS improved by 72.7% in the interventional arm versus 24.2% in the control arm. The interventional arm demonstrated significant KOOS improvements: symptoms by 49.6% (23.2 ± 11.6), pain by 47.1% (26.0 ± 12.8), activities of daily living by 65.4% (30.6 ± 10.9), and quality of life by 67.1% (32.2 ± 12.2), versus worsening by 6% (-3.3 ± 10.4), 2% (-1.3 ± 9.8), 11.6% (-7.4 ± 11.5) and 3.7% (-2.1 ± 9.7), respectively, in the control arm. Minor complications included skin discolouration (n = 1), dissection (n = 2), persistent spasm (n = 1), and contrast extravasation (n = 2). Transient pain exacerbation (∼2 weeks) occurred in 25% (7/28) of embolised knees. One case had a superficial abscess requiring treatment.

single session of GAE in participants with symptomatic KOA improved pain and function at 12 months compared with standard management, without any major complications.