Purpose: Genicular artery embolization (GAE) has potential to provide midterm relief of pain for patients with mild-to-moderate knee osteoarthritis resistant to conservative management.The study compares use of trisacryl gelatin microspheres (ES) to Imipenem/Cilastatin (IMP/CS) particles for GAE on a cohort of patients with two-year of clinical follow-up.
Materials and Methods: In a prospective study, a total of ten patients (15 knees) who had GAE with 100-300 μm ES particles were compared with a subsequent cohort of eleven patients (18 knees) who underwent GAE with IMP/CS. Clinical outcomes were evaluated at 6-month and 24-month follow-up and compared to baseline using WOMAC questionnaire.
Results: There was no significant difference in sex, age, BMI, duration of pain before the procedure, prior treatment, or Kellgren-Lawrence grade between the 2 cohorts. Baseline median pain WOMAC and total WOMAC scores were 13 (IQR 4) and 46 (IQR 4) in the ES group and 13 (IQR 3) and 47 (IQR 28) in the IMP/CS groups [p = .875 and p = .738], respectively.
The median follow-up was 796 days (range, 736-808). Clinical success (50% reduction in WOMAC pain score vs baseline) was achieved in 69.23% of the embolized knee joints in both groups (p=1.0) at 6 months, and 61.5% vs. 53.8% of in ES and IMP/CS groups, at 2-years of follow-up, respectively (p=1.0). Both embolic materials resulted in significant decrease in Pain WOMAC and Total WOMAC scores at 6 months (compared to baseline) (p< 0.05) and the effect of GAE on Pain WOMAC and Total WOMAC scores was sustained until the 24-month follow-up visit in both groups (p< 0.05).
Minor events included transient cutaneous color change (five patients) or transient leg numbness (one patient) and was only identified after GAE with ES particles (p= 0.00387), which resolved spontaneously at 1-month follow-up (Clavien-Dindo classification grade I). There was no major adverse event.
Conclusion: 100-300 μm ES particles can be considered for GAE and is comparable to IMP/CS in pain reduction of moderate to severe knee osteoarthritis and with sustained effect up to two-years of follow-up.