Embolisation of the geniculate arteries, a new treatment for gonarthrosis
Seance of wednesday 25 september 2024 (Arthrose : Nouveaux concepts et nouveaux traitements)
DOI number : 10.26299/qffv-sh62/emem.2024.25.03
Abstract
Objective: a report on genicular arterial embolization as an endovascular treatment of knee osteoarthritis.
Beyond the obvious mechanical origin of knee osteoarthrisis, more and more arguments are emerging to consider osteoarthritis as a chronic inflammatory pathology, in which neoangiogenesis is a cellular lesion commonly found, and also associated with lowered nociceptive thresholds. The objective of embolization is to block neoangiogenesis by injecting small particles (less than 300 microns) into the arteries supplying the synovium and cartilage. This very distal and usually reversible embolization (within an average time of 10 minutes) is a very safe procedure, and major complications are very uncommon. Its place in the
therapeutic arsenal of gonarthrosis could be that of a “bridge treatment” inyoung patients who have failed medical treatment and/or intra-articular injection, in order to postpone the need for a total knee prosthesis. To date, the clinical effect is only supported by small retrospective series and a few prospective studies of small numbers, which found positive
results on pain and functional scores. The double-blind randomized trial Genesis II which comapre embolization versus placebo with possible crossover at 6 months is underway, and could conclude on effectiveness with a higher level of evidence. Long-term effectiveness and the use of resorbable or non-resorbable particles are also outstanding questions.
Beyond the obvious mechanical origin of knee osteoarthrisis, more and more arguments are emerging to consider osteoarthritis as a chronic inflammatory pathology, in which neoangiogenesis is a cellular lesion commonly found, and also associated with lowered nociceptive thresholds. The objective of embolization is to block neoangiogenesis by injecting small particles (less than 300 microns) into the arteries supplying the synovium and cartilage. This very distal and usually reversible embolization (within an average time of 10 minutes) is a very safe procedure, and major complications are very uncommon. Its place in the
therapeutic arsenal of gonarthrosis could be that of a “bridge treatment” inyoung patients who have failed medical treatment and/or intra-articular injection, in order to postpone the need for a total knee prosthesis. To date, the clinical effect is only supported by small retrospective series and a few prospective studies of small numbers, which found positive
results on pain and functional scores. The double-blind randomized trial Genesis II which comapre embolization versus placebo with possible crossover at 6 months is underway, and could conclude on effectiveness with a higher level of evidence. Long-term effectiveness and the use of resorbable or non-resorbable particles are also outstanding questions.