SIR 2024
Pain Management/MSK
Tyler E. Callese, MD
Resident Physician
UCLA
Financial relationships: Full list of relationships is listed on the CME information page.
Lucas R. Cusumano, MD, MPH
resident
ucla
Financial relationships: Full list of relationships is listed on the CME information page.
Hiro D. Sparks, BS
Medical Student
UCLA David Geffen School of Medicine
Disclosure information not submitted.
Kara Masterson, MS, NP, RN
Clinical Nurse Practioner
UCLA Health
Disclosure information not submitted.
Scott Genshaft, MD
Associate Clinical Professor
UCLA Interventional Radiology
Disclosure information not submitted.
Siddharth Padia, MD
Professor
David Geffen School of Medicine at UCLA
Financial relationships: Full list of relationships is listed on the CME information page.
Current evidence suggests the efficacy of genicular artery embolization (GAE) in improving symptoms associated with painful knee osteoarthritis (OA). However, there is a paucity of evidence informing patient selection. The purpose of this study was to analyze clinical, radiographic, and technical factors associated with improved clinical outcomes in GAE.
Materials and Methods:
This IRB-approved single-center study retrospectively analyzed 236 patients who underwent GAE for knee OA between May 2018 and September 2022. Univariate analysis using chi-square and Wilcoxon rank-sum tests and multivariate logistic regression were performed utilizing radiographic, demographic, clinical, and procedural variables to identify factors associated with clinical outcomes in GAE. Pre-procedural OA severity was radiographically evaluated using Kellgren-Lawrence (KL) and Osteoarthritis Research Society International (OARSI) standardized scoring systems. The primary endpoint was clinical success defined as 50% improvement in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score at 1 year.
Results:
Clinical success was reported in 128 patients (54.2%). Amongst patient demographic factors, clinical success was observed in younger patients (67.5 ± 9.4 years vs 71.5 ± 11.1, P< 0.01) with higher BMI (29.7 ± 5.3 vs 27.6 ± 6.4, P< 0.01) relative to clinical failures. Preprocedural radiographic features which correlated with clinical success included lower KL grade (2.8 ± 0.8 vs 3.2 ± 0.8, P< 0.01) and absence of severe OARSI grade 3 medial joint space narrowing (77.9% or 99 of 127 vs 63.6% or 68 of 107, P< 0.01). Amongst procedural factors, embolization of the arterial targets other than the descending genicular artery was associated with the clinical success (53.9% or 69 of 128 vs 35.2% or 38 of 108, P< 0.01). In multivariate logistic regression, these factors remained significantly correlated with clinical success: age (OR = 0.97, P = 0.02), BMI (OR = 1.1, P=0.03), OARSI severe joint space narrowing score of 3 (OR= 0.42, P< 0.01), and sparing of the descending genicular (OR = 2.4, P< 0.01).
Conclusion:
GAE is an effective procedure with high rates of durable clinical improvement at 1 year. Younger patients and those with mild and moderate knee osteoarthritis are associated with significant improvement in clinical response compared to older patients and those with severe or destructive knee osteoarthritis. These findings suggest that early intervention with GAE may be appropriate in patients who are not candidates for, or do not desire, total knee arthroplasty.