Felix Gonzalez, M.D. Assistant professor, Division of Musculoskeletal Imaging Department of Radiology and Imaging Scienc Emory University School of Medicine Atlanta, Georgia
Dr. Gonzalez
PainRelief.com: What is the background for this study? What are the main findings?
Response: Total knee arthroplasty is a common procedure performed worldwide for the treatment of symptomatic knee arthritis. Unfortunately, approximately 20% of those patients develop chronic pain after the surgical intervention in the setting of no complications such as infection or hardware loosening. The reason for this is not known at this point although theories exist.
The new study focused on 21 patients who were experiencing persistent chronic pain after total knee replacement, without underlying hardware complications. The patients had all failed conservative care. They filled out clinically validated questionnaires to assess pain severity, stiffness, functional activities of daily living and use of pain medication before and after the procedure. Follow-up outcome scores were collected up to one year after the C-RFA procedure.
In the end, the study found, patients with knee arthritis reported an 70% drop in their pain ratings approximately, on average.
Professor Kim BennellFAHM Barry Distinguished Professor | NHMRC Leadership Fellow Dame Kate Campbell Fellow Centre for Health Exercise and Sports Medicine Department of Physiotherapy Melbourne School of Health Sciences The University of Melbourne, Victoria Australia
Prof. Bennell
PainRelief.com: What is the background for this study?
Response: Osteoarthritis is a common chronic painful joint condition with no cure that often leads to costly joint replacement surgery. Treatments are needed that can not only reduce symptoms but also slow structural progression of the disease in order to reduce the burden of knee OA. There are no approved disease-modifying treatments available at present.
Platelet-rich plasma (PRP) injections have become a widely used treatment for knee osteoarthritis (OA) in recent years despite the fact that the evidence to support their effects is limited and not of high quality. For this reason, clinical guidelines currently do not recommend PRP for the management of knee osteoarthritis.
To address this gap in knowledge, our study aimed to compare the effectiveness of PRP injections to reduce knee pain and slow loss of medial tibial cartilage volume over a 12-month period. We did this by conducting a clinical trial of 288 people with mild to moderate knee OA. The study included a placebo group where participants were injected with saline into the knee. Participants and the injecting doctors were blind as to whether PRP or saline was injected into the knee.
PainRelief.com Interview with: Stuart L. Silverman MD FACP FACR Clinical Professor of Medicine, Cedars-Sinai Medical Center and UCLA School of Medicine Medical Director, OMC Clinical Research Center Beverly Hills, CA 90211
Dr. Silverman
PainRelief.com: What is the background for this study?
Response: As a practicing rheumatologist, I am aware that prior studies have shown variation in medical care, pain management and treatment with opioids by race and social economic status. Suboptimal treatment of pain in patients with osteoarthritis (OA) may also disproportionately burden racial minorities and Medicaid recipients.
Studies have shown that African Americans are nearly 1.5 times as likely to have symptomatic knee OA than White patients even when adjusting for other factors. Similarly, they also have a higher prevalence of symptomatic and radiographic hip OA. Analyses of Medicare data has shown evidence of persistent racial disparities for joint arthroplasty usage and surgical outcomes.
PainRelief.com Interview with: Dr. Siddharth A. Padia, MD Interventional Radiology Ronald Reagan UCLA Medical Center UCLA Santa Monica Medical Center
Dr. Padia, MD
PainRelief.com: What is the background for this study?
Response: Osteoarthritis (OA) of the knee can be a debilitating condition with significant impact on a person’s overall quality of life. OA has historically been considered a “wear-and-tear” disease, resulting from years of stress induced cartilage degeneration. Recent data suggests that inflammation plays a role not only in the experience of pain secondary to osteoarthritis, but is a driver of OA itself.
Genicular artery embolization (GAE) is a minimally invasive procedure where the arteries supplying the lining of the knee are selectively catheterized during an angiogram to target abnormally increased blood flow associated with knee osteoarthritis. Injection of small, microspheres results in a reduction in arterial flow, which may in turn reduce the synovial inflammation.
PainRelief.com: What are the main findings?
Response: 40 subjects were enrolled in this trial. Technical success was achieved in 100% of subjects. Transient skin discoloration and transient mild post-procedure knee pain were common and expected. Pain scores decreased from a 8 (out of 10) at baseline to 3/10 (63% decrease) at 12 months. Twenty-seven patients (67.5%) had greater than a 50% reduction in pain scores.
PainRelief.com: What should readers take away from your report?
Response: Genicular artery embolization is a highly promising therapy for people with knee arthritis, who are not surgical candidates or which to defer surgery. It is the first non-surgical treatment that has shown to have a significant reduction in pain with a duration of at least one year. It is minimally invasive, and most people can resume their everyday activities the evening after their procedure.
PainRelief.com: What recommendations do you have for future research as a result of this work?
Response: This was a single arm trial, in that genicular artery embolization was not compared to other treatments. Future research needs to show a comparison to other treatments or placebo in order to prove its efficacy. Additionally, long-term result (2 and 4 years) would be beneficial to show the durability of GAE over time.
Citation:
Abstract No. 16 Genicular artery embolization for the treatment of knee osteoarthritis: final results from a prospective investigational device exemption trial Padia, S. et al. Journal of Vascular and Interventional Radiology, Volume 32, Issue 5, S8
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