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Review
. 2023 Feb 6;5(2):100342.
doi: 10.1016/j.ocarto.2023.100342. eCollection 2023 Jun.

Genicular artery embolization for treatment of knee osteoarthritis pain: Systematic review and meta-analysis

Bedros Taslakian  1 , Larry E Miller  2 , Tarub S Mabud  1 , William Macaulay  3 , Jonathan Samuels  4 , Mukundan Attur  4 , Erin F Alaia  5 , Richard Kijowski  5 , Ryan Hickey  1 , Akhilesh K Sista  6
Affiliations
Review

Genicular artery embolization for treatment of knee osteoarthritis pain: Systematic review and meta-analysis

Bedros Taslakian et al. Osteoarthr Cartil Open. .

Abstract

Objective: Genicular artery embolization (GAE) is a novel, minimally invasive procedure for treatment of knee osteoarthritis (OA). This meta-analysis investigated the safety and effectiveness of this procedure.

Design: Outcomes of this systematic review with meta-analysis were technical success, knee pain visual analog scale (VAS; 0-100 scale), WOMAC Total Score (0-100 scale), retreatment rate, and adverse events. Continuous outcomes were calculated as the weighted mean difference (WMD) versus baseline. Minimal clinically important difference (MCID) and substantial clinical benefit (SCB) rates were estimated in Monte Carlo simulations. Rates of total knee replacement and repeat GAE were calculated using life-table methods.

Results: In 10 groups (9 studies; 270 patients; 339 knees), GAE technical success was 99.7%. Over 12 months, the WMD ranged from -34 to -39 at each follow-up for VAS score and -28 to -34 for WOMAC Total score (all p ​< ​0.001). At 12 months, 78% met the MCID for VAS score; 92% met the MCID for WOMAC Total score, and 78% met the SCB for WOMAC Total score. Higher baseline knee pain severity was associated with greater improvements in knee pain. Over 2 years, 5.2% of patients underwent total knee replacement and 8.3% received repeat GAE. Adverse events were minor, with transient skin discoloration as the most common (11.6%).

Conclusions: Limited evidence suggests that GAE is a safe procedure that confers improvement in knee OA symptoms at established MCID thresholds. Patients with greater knee pain severity may be more responsive to GAE.

Keywords: GAE; Genicular artery embolization; Knee; Osteoarthritis; Pain.

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Conflict of interest statement

L. Miller received research support from NYU Langone Health, related to the present manuscript. B. Taslakian received research support from 10.13039/100007210Varian Medical Systems, related to the present manuscript. W. Macauly discloses board membership with AAHKS, CORR, JoA, and Hip Society, and stock ownership of OrthAlign, unrelated to the present manuscript. A. Sista discloses grant payment from NIH, unrelated to the present manuscript. B. Taslakian discloses payment from Advarra for DSMB participation, unrelated to the present manuscript. E. Alaia, M. Attur, R. Hickey, R. Kijowski, T. Mabud, and J. Samuels report no conflicts of interest.

Figures

Fig. 1
Fig. 1
PRISMA study flow diagram.
Fig. 2
Fig. 2
Temporal trends in knee pain and WOMAC Total score following genicular artery embolization. Plotted data are weighted mean and 95% confidence interval. P ​< ​0.001 ​at each follow-up interval.
Fig. 3
Fig. 3
Improvement in knee osteoarthritis symptoms from baseline following genicular artery embolization reported in standardized minimal clinically important difference (MCID) units with 95% confidence interval. The MCID was set at 20 points for knee pain (0–100 scale) and 16.8 points for WOMAC Total score (0–100 scale). Treatment effects below 0.5 MCID units indicate that it is unlikely that an appreciable number of patients will show a clinically important benefit, treatment effects between 0.5 and 1 MCID units indicate that a treatment may be beneficial to an appreciable number of patients, and treatment effects above 1 MCID unit indicate that many patients may gain important benefits from treatment [28,29].
Fig. 4
Fig. 4
Cumulative retreatment rate following genicular artery embolization (GAE). Plotted data are cumulative event rate and 95% confidence interval. At 2 years follow-up, the rate was 5.2% (95% CI ​= ​3.1%–8.4%) for total knee replacement (TKR) and 8.3% (95% CI ​= ​5.6%–12.0%) for repeat GAE.
Fig. 5
Fig. 5
Frequency of adverse events following genicular artery embolization. Plotted values are weighted event frequency and 95% confidence interval.
See this image and copyright information in PMC

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