Dr Nimit Goyal, Consultant Interventional Radiologist
Dr Rebecca Wallace, Radiology Quality & Governance Manager
Mr Andrew S Miller, Consultant Trauma and Orthopaedic Surgeon
Aneurin Bevan University Health Board
Osteoarthritis (OA) is considered a condition of musculoskeletal (MSK) pain with approximately 450,000 individuals living with OA in Wales (Versus Arthritis OA Calculator). Mild to moderate knee OA, not yet severe enough to warrant joint replacement, and resistant to nonsurgical options, represents a specific management challenge.
Current treatment options include physiotherapy and drug interventions. The pathogenesis of OA appears to be multi-faceted, with angiogenesis borne out of inflammatory processes theorised to play a significant role in the OA-associated pain. Geniculate artery embolization (GAE) is an interventional radiology procedure that aims to relieve pain related to OA by embolising the pathological new vessels while maintaining the larger vascular supply to the bone. It is done as a day case using local anaesthesia. A catheter is passed in the femoral artery and then angiography is performed to identify the blood vessels supplying the area of increased vascularity. Once the abnormal new vessels are identified, a microcatheter is navigated into them under X-ray guidance. Tiny embolization particles are then delivered to the area of increased vascularity until the blood flow is stopped. GAE is the focused embolization the pathological neovessels, with preservation of the genicular artery.
Aim:
This project looks to explore the effectiveness of this novel interventional radiological procedure, genicular artery embolization, as a treatment option to reduce pain and improve joint mobility and overall quality of life and wellbeing in those patients living with mild- moderate osteoarthritis of the knee. As the first known study in Wales to investigate the potential benefits of this embolization procedure, it is hoped this study will realise the benefits of this intervention and lead ultimately to widespread adoption within Wales.
Outcomes/ Benefits:
- 21 cases recruited for GAE
- 90% patient satisfaction
- All reduced their VAS pain score at 1 month follow up
- Significant interest from orthopaedics, AHP physios and another health board
What Next:
- Patients to be followed up for 18 months, further data and evaluation to be completed
- NICE review of GAE
- Gwent IR established as a skilled site for GAE
- Offer all Wales procedure and training site at The Grange University Hospital – awarded ‘Exemplar Site’
- Explore application for other conditions such as tennis elbow, frozen shoulder, plantar fasciitis.
