Geniculate Artery Embolization for Knee Osteoarthritis
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Osteo Arthritis Knee
- Sponsor
- University of Calgary
- Locations
- 1
- Primary Endpoint
- Patient Pain (mm): visual analog scale
- Status
- Withdrawn
- Last Updated
- 5 years ago
Overview
Brief Summary
A prospective cohort study to study the effectiveness and safety profile of geniculate artery embolization for the treatment of symptomatic knee osteoarthritis.
Detailed Description
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.
Investigators
Ani Mirakhur
Clinical Assistant Professor
University of Calgary
Eligibility Criteria
Inclusion Criteria
- •Moderate to severe knee pain (visual analog scale (VAS) \> 50 mm), and
- •Pain refractory for at least 3 months of conservative therapies (anti-inflammatory drugs, physical therapy, muscle strengthening or intra-articular injections), and
- •Kellgren-Lawrence grade 1, 2 or 3 on knee radiograph, and
- •MRI features of active synovitis (Synovial thickening and/or enhancement on MRI using pre-gadolinium sagittal T2-weighted/proton-density sequences and post-gadolinium T1 weighted imaging, respectively), and
- •Willing, able and mentally competent to provide written informed consent (to ensure that all study subjects demonstrate an understanding of the risks of the procedure and participate in the informed consent), and
- •Not eligible for surgical arthroplasty within 1 year of estimated procedure date
Exclusion Criteria
- •Major surgery within the past six weeks (excluding arthroscopic/meniscal interventions), or
- •Ipsilateral knee intra-articular injection in the last 3 months, or
- •Pregnant or attempting to become pregnant during study period, or
- •Current local infection, or
- •Life expectancy less than 6 months, or
- •Known advanced atherosclerosis, or
- •Rheumatoid or seronegative arthropathies, or
- •Infectious arthritis, or
- •Prior knee surgery (excluding arthroscopic/meniscal interventions), or
- •Uncorrectable coagulopathy including international normalized ratio (INR) \> 1.5 or platelets \< 50,000, or
Outcomes
Primary Outcomes
Patient Pain (mm): visual analog scale
Time Frame: 1 year
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.
Patient function (arbitrary units)
Time Frame: 1 year
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.
Secondary Outcomes
- Medication use (arbitrary units)(1 year)
- Synovitis (arbitrary units)(1 year)
- Physical function (arbitrary units)(1 year)