Geniculate Artery Embolization

Knee Pain

There is no definition of knee pain. If you have it, you know there are few things worse. You may also have observed people suffering from knee pain and would have seen the misery they live in along with the effect knee pain has on quality of life.

Causes & Treatment

It is difficult to put a finger on causes of Knee pain. Injury from an accident, fall or a sports injury are generally cause of pain in young & otherwise healthy beings. However, as age increases number of factors causing pain in the knee, increase manifold - from muscle weakness, bone issues, weight issues, any underlying condition causing inflammation, arthritis, or simple wear & tear.

As there is no easy way to identify cause of knee pain similarly there is no easy and effective treatment therapy for knee pain. If the knee pain is caused by specific injury, mostly the patient is expected to get full relief as the injury heals.

However, knee pain which occurs not due to direct injury to the knee but due to an underlying condition, there is no direct treatment. In most cases, patients’ treatment commences with regular physical therapy & medication. If started timely, physical therapy can provide symptomatic relief and significantly delay any worsening of the condition. In many cases though with time the underlying condition gets worse and so the knee pain. Osteoarthritis is one such major condition.

There is no cure for Osteoarthritis. Though there exist optional therapies which may provide symptomatic relief and delay the progression of the condition.

When the patient gets severe knee pain, conventional treatment options progress from physical therapy to joint injections to joint replacement. However, these treatments do come with their own set of issues – apart from being costly & not full proof treatment option with possible side effects, these treatment options have long list of exclusion criteria for patients i.e., many patients may not be eligible for these treatments.

New Treatment Option

In modern era there are new technology and treatment protocols – like Geniculate Artery Embolization (GAE) which have shown promising results across spectrum in providing relief from knee pain to osteoarthritis patients. It is these results basis which the procedure has been approved by medical governing bodies across the world. We shall detail about the procedure in the later portions of this article.

What is Knee Osteoarthritis

It is condition which affects approximately 25% of adult population globally. Knee Osteoarthritis (OA) happens when cartilage in your knee is damaged which makes the bones in the joint rub together. This results in friction, pain, loss of functionality.

We assume you know about knee osteoarthritis however you should note that while OA is considered “wear & tear” disease resulting from stress induced cartilage and meniscal degeneration recent research and studies have shown that inflammation plays a role not only in the experience of pain secondary to OA but also as a main cause of OA progression itself.

Today it is known that inflammatory mediators secreted from the synovium contribute to joint tissue destruction. As a sequel of synovial inflammation, vascular cell spread occurs, providing inflammatory cells access to the synovium and other joint tissues thus promoting cellular growth and inflammation in regional vessels, which furthers the destruction of bone and cartilage. This angiogenesis (i.e. development of new blood vessels) in fact contributes to chronic pain by enabling the growth of unmyelinated sensory nerves alongside.

These mediators, including cytokines, nitric oxide, prostaglandin E2, and neuropeptides, produced by the inflamed synovium, alter the balance of cartilage matrix. Excess enzyme release ultimately contributes to cartilage destruction, which in turn results in synovial inflammation in a typical vicious cycle.

What is Geniculate Artery Embolization & How it helps

As highlighted in the article above, Geniculate Artery Embolization (GAE) does not cure osteoarthritis however it has shown promising results in providing significant symptomatic relief to the patients and delay the need for surgical intervention.

As swelling of synovium is associated with clinical symptoms and reflects joint degradation in OA, synovium-targeted therapy could help to alleviate the symptoms of the disease and perhaps prevent structural progression.

Genicular artery embolization (GAE) is a novel minimally invasive procedure, in which the genicular arteries supplying the synovial lining of the knee are selectively catheterized during an angiogram to target aberrant neo vasculature associated with knee OA. The injection of small, calibrated microspheres results in a reduction in arterial flow, which may in turn reduce the synovial inflammation.

GAE is performed by an interventional radiologist who makes use of imaging modalities like X-ray while performing the minimally invasive procedure. Doctor will insert a small catheter into patient’s upper thigh artery and guide the catheter to the arteries supplying blood to the synovium membrane. Doctor than injects minute particles in thereby reducing the blood supply to these arteries which in turn reduces inflammation and ultimately reduces knee pain.

GAE mostly does not require hospital stay though doctors sometimes do keep patients under observation to avoid undue stress on the knee. Though mostly patients can return home on same day of the procedure and return to their routine activities within 48 hours unlike any other surgical treatment which requires long hospital stays and significantly longer recovery period.

While many patients experience immediate relief from pain, it is noted that some patients start experiencing relief in two weeks. Very interesting point to note is that the relief for patients is not short term like with pain injections, but pain relief is experienced for long term thus significantly improving quality of life for the patient.

ASK YOUR DOCTOR - if Genicular artery embolization is an option for you

It is a great therapy to be evaluated before considering surgical intervention. Without any known side effects this is also a therapy available to patient who do not have surgery as their option. However, do note that applicability of this treatment option can only be confirmed by doctor after clinical evaluation. Though patient should surely ask the treating doctor if GAE the minimally invasive procedure is applicable to them and discuss with the doctor.