Long-Term Clinical Outcomes of Simplified Transarterial Microembolization (Dochu) for Proximal and Distal Interphalangeal Joint Osteoarthritis

Proximal and distal interphalangeal joint osteoarthritis (PIP/DIP-OA) is a leading cause of chronic hand pain and long-term hand disability among the elderly. The aim of this study was to report the 3-year outcomes of simplified transarterial microembolization, or Dochu, in PIP/DIP-OA.

Materials and Methods:

This is a retrospective, single-arm, cohort study of 171 patients (mean age 58 ± 7.5; 86% female) with PIP/DIP-OA who underwent Dochu between January 2022 and October 2022 (Table 1). Dochu was performed by infusing a mixture of 0.1 g of imipenem/cilastatin sodium in 1.0 mL normal saline through a 27-gauge needle percutaneously inserted into the radial and/or ulnar artery under ultrasound guidance. Distal distribution of the embolic material was assessed by evoked pain and transient cutaneous color changes of the fingers. A treatment-specific, patient-reported questionnaire was obtained at baseline, 3 months, 6 months, 1 year, and 3 years post-treatment.

Results:

Technical success, defined by evoked pain and transient cutaneous color changes of the symptomatic fingers after intra-arterial embolic injection, was achieved in all patients. Clinical success, defined by a reduction of ≥ 2 points in the Numeric Rating Scale (NRS) pain score within 1 year of initial treatment, was achieved in 85% of patients. Among responders, 92% maintained their response for 24 months and 81% maintained their response for 33 months. The mean NRS pain score decreased from baseline to 3 months, 6 months, 1 year, and 3 years post-treatment (6.0 vs 3.2, 2.7, 2.7, and 2.7, respectively, all p < 0.0001). Australian and Canadian Hand Osteoarthritis Index scores also decreased from baseline to 3 years post-treatment: pain (8.9 to 3.9, p < 0.0001), function (12.2 to 6.1, p < 0.0001), stiffness (1.3 to 0.9, p = 0.0008), and total (22.3 to 11.0, p < 0.0001). Evaluation of individual joints demonstrated significant rates of pain resolution at the bilateral DIP joints and thumb base. Use of conservative treatments for PIP/DIP-OA decreased after Dochu. There were no major adverse events. 41 patients were lost to follow up.

Conclusion:

Dochu demonstrated promising long-term safety and efficacy in the treatment of PIP/DIP-OA. Dedicated, randomized controlled trials can further validate its clinical utility.