Knee Osteoarthritis Embolization

Genicular artery embolization is a minimally invasive procedure performed by interventional radiologists to treat chronic knee pain. This technique involves occluding the genicular arteries (arteries supplying the knee region) to reduce blood flow to the affected area, thereby decreasing inflammation and relieving pain.

It is primarily used to treat knee osteoarthritis, particularly when pain is poorly controlled by other treatments.

It is the degradation of joint cartilage that can cause pain and inflammation in the knee region. Some osteoarthritis may go through phases of swelling (joint effusion) and inflammation of tissues around the joint (synovitis). Currently, no treatment can effectively repair damaged knee cartilage.

Among osteoarthritis treatments, analgesic therapy, physiotherapy, and surgery should be distinguished. The most effective treatment remains total knee replacement by an orthopedic surgeon, but with operative risks and limited prosthesis lifespan.

Embolization is a new treatment, still under evaluation, that can reduce symptoms and pain by acting on inflammation. It can in no way replace surgery when surgery is absolutely necessary.

• Patients with recurrent hemorrhagic joint effusion (hemarthrosis).
• Young symptomatic patients awaiting prosthesis.
• Rare cases of residual pain despite total knee replacement.
• Patients with painful osteoarthritis who are contraindicated for surgery.

Diagnosis is based on a detailed clinical examination and imaging studies:

• Knee X-ray
• MRI: This examination evaluates the condition of bony and articular structures of the knee and detects signs of osteoarthritis or inflammation. More precise than X-rays, it can detect signs of synovitis when performed after contrast injection.

Genicular artery embolization is performed under local anesthesia or light sedation. The procedure is generally performed on an outpatient basis, meaning the patient can return home the same day. Here are the main steps:

1. Vascular access: A catheter is inserted into the femoral artery at the groin level.
2. Arterial navigation: The catheter is guided under radiological control (often fluoroscopy) to the genicular arteries of the knee.
3. Angiography: Contrast material is injected to obtain detailed images of the knee arteries and precisely determine the inflammatory areas to embolize.
4. Embolization: Once the catheter is correctly placed, resorbable embolization material (such as a contrast mixture or micro-particles) is injected to obstruct the targeted arteries, thereby reducing blood flow to the painful area.

Genicular artery embolization is indicated in patients with moderate to severe osteoarthritis for whom conventional treatments such as anti-inflammatories, injections, or physiotherapy are no longer effective. It is also an alternative for those wishing to avoid or delay surgery such as joint replacement. Patients must still have a functional joint, as this technique aims to preserve articular structures and improve mobility.

Although embolization is a relatively safe procedure, it carries certain risks, including:

• Infection: A risk of infection at the catheter insertion site is possible, although rare.
• Hematoma: Bruising may appear where the catheter was inserted.
• Post-procedural pain: Temporary discomfort or mild pain may persist after the procedure.
• Embolization material side effects: Rarely, an allergic reaction to embolization materials may occur.
• Transient skin ulcerations or redness: When they occur, they heal spontaneously in most cases.
• Symptom recurrence: Although embolization is effective, residual or recurrent symptoms may occur in some cases.

After genicular artery embolization:

• Follow-up is recommended with radiological assessment after a few months to evaluate procedure effectiveness.
• Return to light activities is possible in the days following the procedure.
• It is advisable to avoid intense physical exertion for 2 weeks.
• Temporary work leave may be prescribed.