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Geniculate Embolization

Geniculate Artery Embolization

Patient with knee pain or bloody joint effusions are often informed that surgery or medicine are their only options. Non-surgical treatment called geniculate artery embolization, on the other hand, maybe an effective alternative option for osteoarthritis and hemarthrosis.

Osteoarthritis

Connective tissue called cartilage acts as a lubricant in joints, making it possible to move freely. Over time these can wear down and the joints can become inflamed causing what is called osteoarthritis (OA). 32.5 million Americans are affected with OA each year. The knee, hands, elbows, and spine are the most common locations.1,2

Hemarthrosis

Hemarthrosis is when there is bleeding into the knee joint cavity. Pain, tenderness, redness, swelling, warmth, and stiffness in the affected joint are some of the symptoms. Bruising may be visible in the area around the joint.

Postoperative hemarthrosis most commonly occurs after arthroscopic surgery, such as a total knee replacement. Recurrent hemarthrosis occurs in about 0.3% of people who have had a total knee replacement. Repetitive trauma and inflamed hypervascular synovial tissue causes bleeding in the joint. Typically, these joints are aspirated yielding bloody fluid. Some patients however do not respond well to conservative measures and experience continued bleeding into the joint. Hemarthrosis embolization is an option for those who need a more permanent solution.

Blood thinners, osteoarthrosis, hemophilia, and malignancies in the joint are also other potential causes of hemarthrosis.

Why Treat Hemarthrosis

After knee replacement surgery, if hemarthrosis develops and the patient does not receive treatment, the joint can be further damaged causing stiffness and loss of range of motion. This can lead to muscular weakening as well. Infection of the joint can occur as well.

Current Treatments for Hemarthrosis

Ice and rest of the joint, elevation of the leg, and pain medication are typically first line treatments. This may be all that is required for patients in some cases.

Aspiration, surgical excision of the synovial tissue, or embolization can also be used to treat recurrent hemarthrosis. If a patient fails conservative management and aspiration, embolization procedure may be explored as a minimally invasive option.

Geniculate Artery Embolization

Why Treat Osteoarthritis

Osteoarthritis is a chronic process that worsens over time causes discomfort, swelling and reduced range of motion in the joint. Progressive symptoms would not be ideal in an active patient or someone who does not want to be on pain medication long term.

Current Treatments for Osteoarthritis

Treatment regimens include a variety of medications that aim to slow or stop its progression. Symptomatic care with ice packs to reduce swelling, heating pads to ease pain, and NSAIDs like ibuprofen to alleviate discomfort.2,4

Osteoarthritis that is both painful and accompanied by mobility impairment necessitates surgical intervention. Surgical options include arthroscopy, cartilage repair, osteotomy, and joint replacement.4

However, there is a period in this disease process where conservative measures are not working or ideal, and the joint is still too healthy and functional for surgery. In this period, embolization can provide symptom relief until there is enough joint disease warranting joint replacement surgery.

Embolization

During an embolization, the blood supply to a specific location is cut off. Geniculate artery embolization specifically cuts off the blood supply to the inflamed tissues of the knee joint.

The geniculate arteries extend into the knee joint and can cause sporadic bleeding or pain if inflamed and are frequently the source of the problem.

Geniculate Artery Embolization: Procedure

Embolization is an outpatient non-surgical procedure with a short recovery. The patient is given a mild sedative and a local topical anesthetic to help numb the skin. A tiny catheter is inserted and guided to the knee using an x-ray system that provides moving photographs in “real time.”

Embolism of the geniculate artery is completed by injecting sand-sized particles into the catheter. The blood arteries become blocked with the particles, resulting in a lack of blood flow to the abnormal tissues of the joint reducing inflammation and pain.8,9

Patients are discharged one to two hours after the treatment, and pain relief typically begins within two weeks. As the procedure is minimally invasive, the incidence of any complications is very low. Patients might experience bruising or pain at the injection site. Some rare complications for GAE include allergic reactions, infection, bleeding/bruising, skin irritation.

Geniculate Artery Embolization: Results

Current data shows promising results in relieving osteoarthritis. There was a 61% and 67% drop in WOMAC and VAS pain levels, respectively, throughout a 12-month period in research.5 Clinical investigations have revealed that after GAE, pain is significantly reduced. The demand for medications such as analgesics was also reduced. There were also no major adverse effects or complications during or following the treatment, according to the research.7

For hemarthrosis, embolization has a technical success rate over 90%. After 26.8 months of follow-up, the clinical success rate is 89%, which means that 89% of patients are symptom-free.

Geniculate Artery Embolization

Geniculate Artery Embolization

References

  1. Lombardi M, Cardenas AC. Hemarthrosis. [Updated 2020 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525999/
  2. Medical News Today. All you need to know about hemarthrosis by Tom Seymour. Date: December 27, 2017. https://www.medicalnewstoday.com/articles/320443#
  3. Hemarthrosis by Jacquelyn Cafasso, medically reviewed by Graham Rogers, M.D. Updated on June 14, 2017. https://www.healthline.com/health/hemarthrosis
  4. The Hemophilia, von Willebrand Disease & Platelet Disorders Handbook. Joint Bleeds. https://www.hog.org/handbook/article/3/33/joint-bleeds
  5. Yoo JH, Oh HC, Park SH, Lee S, Lee Y, Kim SH. Treatment of Recurrent Hemarthrosis after Total Knee Arthroplasty. Knee Surg Relat Res.  2018;30(2):147-152. doi:10.5792/ksrr.17.059. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5990227
  6.  National Cancer Institute. Arterial embolization.https://www.cancer.gov/publications/dictionaries/cancer-terms/def/arterial-embolization
  7. Maheshwari R, Kelley SP, Langkamer VG, Loveday E. Spontaneous recurrent haemarthrosis following unicompartmental knee arthroplasty and its successful treatment by coil embolisation. Knee. 2004;11:413-5.
  8. van Baardewijk LJ, Hoogeveen YL, van der Geest ICM, Schultze Kool LJ. Embolization of the Geniculate Arteries Is an Effective Treatment of Recurrent Hemarthrosis Following Total Knee Arthroplasty That Can Be Safely Repeated. J Arthroplasty. 2018 Apr;33(4):1177-1180.e1. doi: 10.1016/j.arth.2017.11.002. Epub 2017 Nov 24. PMID: 29224993. https://pubmed.ncbi.nlm.nih.gov/29224993
  9. Osteoarthritis – Symptoms and causes – Mayo Clinic. Accessed March 2, 2022. https://www.mayoclinic.org/diseases-conditions/osteoarthritis/symptoms-causes/syc-20351925
  10. Osteoarthritis (OA) | Arthritis | CDC. Accessed March 2, 2022. https://www.cdc.gov/arthritis/basics/osteoarthritis.htm
  11. Osteoarthritis | National Institute on Aging. Accessed March 2, 2022. https://www.nia.nih.gov/health/osteoarthritis
  12. Rönn K, Reischl N, Gautier E, Jacobi M. Current surgical treatment of knee osteoarthritis. Arthritis. 2011;2011:1-9. doi:10.1155/2011/454873
  13. Padia SA, Genshaft S, Blumstein G, et al. Genicular Artery Embolization for the Treatment of Symptomatic Knee Osteoarthritis. JB & JS open access. 2021;6(4). doi:10.2106/JBJS.OA.21.00085
  14. Heller DB, Beggin AE, Lam AH, Kohi MP, Heller MB. Geniculate Artery Embolization: Role in Knee Hemarthrosis and Osteoarthritis. Radiographics. 2022;42(1):289-301. doi:10.1148/RG.210159/ASSET/IMAGES/LARGE/RG.210159.VA.JPEG
  15. Torkian P, Golzarian J, Chalian M, et al. Osteoarthritis-Related Knee Pain Treated With Genicular Artery Embolization: A Systematic Review and Meta-analysis. Orthopaedic journal of sports medicine. 2021;9(7):23259671211021356. doi:10.1177/23259671211021356
  16. van Zadelhoff TA, Moelker A, Bierma-Zeinstra SMA, Bos PK, Krestin GP, Oei EHG. Genicular artery embolization as a novel treatment for mild to moderate knee osteoarthritis: protocol design of a randomized sham-controlled clinical trial. Trials. 2022;23(1):1-8. doi:10.1186/S13063-021-05942-X/TABLES/1
  17. Society of Interventional Radiology – SIR 2021 knee pain. Accessed March 2, 2022. https://www.sirweb.org/media-and-pubs/media/news-release-archive/sir-2021-knee-pain-031621/
  18. Geniculate Artery Embolization for the Treatment of Knee Pain Secondary to Osteoarthritis NCT number NCT02850068. Published online 2017.

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Back Pain/Spinal Fracture

Kyphoplasty

Kyphoplasty is a new minimally invasive technique in vertebral compression fractures. It is primarily performed for patients who suffer vertebral fracture due to diminished bone strength.

Patients who benefit the most from kyphoplasty include those with osteoporosis or age related bone loss. In addition, steroids also weaken the bones of young people, who then face the risk of compression fractures.

Purpose of Kyphoplasty

stop the pain associated with the fracture

stabilize the vertebra

restore vertebral body height

Kyphoplasty is one of the latest breakthroughs in the field of minimally invasive techniques. Since the technique was adopted in 1998, more than 200,000 kyphoplasties have been performed worldwide.

By achieving fracture stabilization and correction of spinal deformity, patients experience significant reduction in pain and improvement in mobility, thus leading to an overall improvement in the quality of life.

Kyphoplasty Procedure

Kyphoplasty uses a two-step process, inclusive of inserting a special balloon device and injection of the bone cement.

It involves an introduction of a cannula into the vertebral body followed by the insertion of an inflatable balloon. The balloon is inserted through tiny incisions along the spine and then inflated to expand the broken bone.

Once done, the bone cement is then injected into the fracture. This restores height and stabilizes the compressed vertebra. After the balloon is removed, there is an empty space within the vertebral body that allows for the low-pressure injection of the cement-like material polymethylmethacrylate into the cavity created by the balloon.

The procedure might be performed under intravenous sedation and the patient might be administered a local or general anesthetic.

Results

Kyphoplasty is considered most successful in restoring bone height and correcting deformity if done on relatively recent fractures, diagnosed within two to three months. Patients are able to return home the same day and resume their daily activities almost immediately after the surgery.

The above information is not all inclusive of the risks, alternatives and benefits. It is not meant to be a substitute for informed discussion between you and your doctor, but can act as a starting point for such a discussion. There are complications possible with any medical procedure. Overall, minimally invasive procedures have a lower complication rate than open surgeries.

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