A prospective cohort study to study the effectiveness and safety profile of geniculate artery embolization for the treatment of symptomatic knee osteoarthritis.
Purpose: The investigators aim to determine whether geniculate artery embolization is a safe treatment for symptomatic knee osteoarthritis and confirm published reports of sustained post-procedural pain relief, improved physical function and investigate potential improvements in joint function quantitatively through imaging and targeted assessments. Participants:Twenty patients with moderate to severe knee pain, pain refractory for 3 months of conservative therapies, imaging features of symptomatic osteoarthritis and ineligible for arthroplasty for 1 year. Procedures (methods): Patients will undergo a brief clinical evaluation to verify eligibility through inclusion and exclusion criteria in addition to a comprehensive joint pain treatment history will be recorded including active analgesic and anti-inflammatory use. A pre-procedural MRI will be completed to assess the extent of their osteoarthritis, signs of active synovitis and vascular anatomy of the knee. Evaluations post geniculate artery embolization will occur at 24 hours, 1, 6 and 12 months to assess for changes in knee pain and joint function and monitor adverse events. An MRI will be performed at the 6 month visit to detect changes in synovitis and exclude complications.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Embolization is a procedure completed by an Interventional Radiologist in which abnormal blood vessels are blocked for treatment purposes. In the case of geniculate artery embolization, abnormal blood vessels which supply your knee joint are blocked in an effort to reduce inflammation and subsequently and reduce pain and improve joint function.
South Healthy Campus
Calgary, Alberta, Canada
Patient Pain (mm): visual analog scale
Severity of pain as assessed by visual analog scale. The visual analog scale is a 100 mm horizontal line with 0 mm correlating with "No Pain" and 100 mm with "Worst Possible Pain". Accompanying the verbal description is an illustrative guide correlating values to facial expressions. Patients mark their responses with a single vertical line. Results will be recorded prior to the procedure and afterwards at each follow-up visit to measure for changes in knee pain.
Time frame: 1 year
Patient function (arbitrary units)
Knee injury and Osteoarthritis Outcome Score (KOOS) will be used to measure joint function. This is a questionnaire in which questions regarding pain, other symptoms, function in activities of daily living, function in sport and recreation and knee-related quality of life are answered to calculate subscale scores. Each subscale (symptoms, activities of daily living, sport and recreation, quality of life) is scored from 0 to 100 with 0 representing extreme symptoms and 100 indicating no symptoms). The questionnaire will be completed at follow-up evaluations to measure change in each subscale from baseline (prior to intervention). Investigators will analyze scores to determine if patient's subjective joint function changes.
Time frame: 1 year
Medication use (arbitrary units)
Change in number or dosage of osteoarthritis medical therapy including oral, topical medications and joint injections will be recorded. Number will be defined as total number of medications used for knee osteoarthritis. Dosage will be defined as the frequency of administration multiplied by the dose of each administration (i.e. 200 mg, 3 times daily will be scored as 600 mg daily). Values will be recorded at each follow-up visit to measure change from baseline and summarized with simple statistics (i.e. percentage of patients with a decrease in medication use).
Time frame: 1 year
Physical function (arbitrary units)
Change in physical function performance will be assessed with a 30 second chair stand test.
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Time frame: 1 year
Synovitis (arbitrary units)
A semiquantifiable synovitis scoring scale on contrast enhanced MRI will be used to assess change in synovitis as proposed by Guermazi et al. in 2011. Synovial thickness will be scored semiquantifiably from grade 0 to 2 at 11 anatomical locations. Grading is calculate by meausrement of maximal synovial thickness with 2 mm or less scored as grade 0, 2-4 mm as grade 1 and \> 4 mm as grade 2. Grading at each location are summed to compute a total synovitis score with a minimum score of 0 representing no synovitis and a maximal score of 22 representing severe synovitis. Investigators will compare scores calculated at a 6 month contrast enhanced MRI to those obtained prior to intervention to assess for changes in synovitis.
Time frame: 1 year