Knee pain improvement after genicular artery embolization for the management of knee osteoarthritis: an updated systematic review and meta-analysis of 21 studies

Abstract

Background: Knee osteoarthritis is a progressive inflammatory musculoskeletal disease with a prevalence of approximately 15-23% and limited treatment options. In recent years, transcatheter genicular artery embolization (GAE) has been proposed due to promising results concerning symptomatic knee pain relief and mobility.

Objective: This systematic review and meta-analysis aimed to evaluate the aggregated data on the safety and efficacy of GAE for pain reduction in the treatment of knee osteoarthritis.

Materials and methods: A systematic search of the three major databases (MEDLINE, Embase, and CENTRAL) from inception to 27 February 2024 was conducted according to the PRISMA guidelines. Studies reporting pain reduction according to the Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)-Total, WOMAC-Pain, and Knee Injury and Osteoarthritis Outcome Score (KOOS)-Pain scales and adverse event rates were included. Meta-analysis was performed by estimating the mean differences and by fitting random-effect models.

Results: Overall, 21 studies were included, comprising of 633 patients and 758 knees treated. The combined data analysis showed that patients who underwent GAE demonstrated mean declines in the VAS score of -38.5 points (95% confidence interval [CI]: -44.9, -32.0) at 1 month, -36.2 points (95% CI -43.0, -29.5) at 3 months, -40.3 points (95% CI: -49.0, -31.7) at 6 months, and -40.5 points (95% CI: -54.5, -26.6) at 12 months. Similarly, significant differences at all time points were also found for the WOMAC-Total, WOMAC-Pain, and KOOS-Pain scores. No difference between permanent and non-permanent embolic material was found in the subgroup analysis for all time points.

Conclusion: Genicular artery embolization is safe and effective for the treatment of painful knee osteoarthritis. This result was not affected by the type of embolic material used (permanent vs. non-permanent).

Keywords: Embolization; Genicular artery embolization; Knee; Osteoarthritis; Pain.