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. 2024 Nov;20(4):508-514.
doi: 10.1177/15563316231183971. Epub 2023 Jul 6.

Genicular Artery Embolization: A Promising Treatment Option for Recurrent Effusion Following Total Knee Arthroplasty

Rex W Lutz  1 , Zachary D Post  2 , Hope S Thalody  1 , Miranda M Czymek  3 , Danielle Y Ponzio  2 , Christopher E Kim  4 , Alvin C Ong  2
Affiliations

Genicular Artery Embolization: A Promising Treatment Option for Recurrent Effusion Following Total Knee Arthroplasty

Rex W Lutz et al. HSS J. 2024 Nov.

Abstract

Background: Selective genicular artery embolization (GAE) has shown promise as a minimally invasive treatment option for persistent symptomatic recurrent effusions (REs) following total knee arthroplasty (TKA).

Purpose: We sought to investigate the radiographic and clinical success of GAE for RE after TKA.

Methods: We performed a retrospective review of prospectively collected data on primary and revision TKA patients with RE, both hemorrhagic and non-hemorrhagic, who underwent GAE between 2019 and 2021 with a minimum of 6-month follow-up. All embolization procedures were performed by a single interventional radiologist. Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and visual analog scale (VAS) scores were collected prior to GAE and at 1, 3, and 6 months post-procedure. Recurrence of effusion following GAE was assessed at 6 months using ultrasound.

Results: Seventeen patients, 10 female and 7 male, with 18 TKAs and a mean (SD) age of 63.1 (8.6) years were included. We saw a mean (SD) of 36.1 (24.4) and 3.3 (3.0) point improvement in WOMAC and VAS scores, respectively. In addition, 14 of the 18 TKAs (77.8%) seen at final follow-up had complete resolution of effusion confirmed by ultrasound.

Conclusion: Our retrospective review found that a majority of patients showed significant clinical improvement and resolution of effusion following GAE. These findings suggest that GAE may be an effective minimally invasive treatment option for RE following TKA and should be further investigated.

Keywords: effusion; embolization; genicular artery embolization; interventional radiologist; recurrent hemarthrosis; total knee arthroplasty.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: ZDP reports relationships with Orthodevelopment and Depuy. DYP reports relationships with Depuy. ACO reports relationships with Smith and Nephew and Stryker. The other authors declared no potential conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Pre-embolization angiography of a TKA with RE. Angiography demonstrating early filling of tortuous genicular vessels (left). Late filling demonstrating hypertrophic vascularized synovium (right, red arrows).
Fig. 2.
Fig. 2.
Pre- and post-embolization angiography. Completion angiography after superselective superior medial, superior lateral, anterior tibial recurrent, descending genicular, and inferior medial genicular artery embolization with delayed imaging demonstrating markedly decrease synovial vascularity.
Fig. 3.
Fig. 3.
WOMAC Score vs. Time. There was a mean reduction of WOMAC scores by 36.1 over the study period. The reported MCID for WOMAC improvement is 10.0.
Fig. 4.
Fig. 4.
VAS Score vs. Time. There was a mean reduction of VAS scores by 3.3 over the study period. The reported MCID for VAS improvement is 2.26.
Fig. 5.
Fig. 5.
Clinical photo of skin ischemia post-embolization. photo demonstrating localized skin ischemia experienced by one patient. Initial image (left), 3-month follow-up (middle), and 6-month follow-up (right). Completely resolved at 6 months with observation.
See this image and copyright information in PMC

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