A Novel Approach to Relieving Osteoarthritis-Related Knee Pain

Reducing inflammation in the arteries of the knee

Blood is supplied to the knee via small blood vessels called the "genicular arteries." Osteoarthritis can lead to the growth of abnormal blood vessels from these arteries, causing inflammation and knee pain.

GAE takes a targeted approach to reduce painful inflammation in the genicular arteries. During the procedure, an interventional radiologist inserts a thin catheter (tube) into the blood vessels through a small incision, usually in the groin. Using wires and advanced imaging technology, they thread the catheter to the knee area.

The interventional radiologist then injects tiny particles into any genicular arteries showing signs of inflammation. These particles partially block blood flow to the vessels, thus easing the knee pain. Finally, the catheter is removed and the incision site is bandaged. No stitches are required.

GAE typically takes about two hours, and patients almost always go home the same day. Most people can return to normal activities within two weeks and experience pain relief for at least one year.

"Doctors in Japan started exploring GAE around 2015, and it's becoming more common in the United States," Dr. Epelboym said. "Even so, awareness of the procedure is pretty low among both patients and physicians."

An early adopter and vocal proponent of GAE

Dr. Epelboym, an early adopter of GAE, led efforts to bring the service to Mass General Brigham. He performs GAE about 50 times a year and conducts research focused on improving the procedure's effectiveness and patient outcomes. He also presents at national and international meetings to educate other physicians on the topic.

"There's a lot of interest in GAE because management of knee pain is very challenging," Dr. Epelboym said. "Oftentimes, patients try multiple therapies, like anti-inflammatories, steroid injections, and physical therapy, and continue to experience pain."

During her first appointment, Dr. Epelboym presented Chris with all of her osteoarthritis treatment options. He stressed that knee replacement is the gold standard for treating severe osteoarthritis. But for someone like Chris, who placed a high priority on avoiding surgery, GAE was a good alternative.

"I was really impressed with Dr. Epelboym," Chris said. "He was upfront about the fact that while GAE wasn't a cure-all, it should provide me with pain relief. At the end of the conversation, I said I wanted to set up a time to have it done."

Symptoms worsen prior to procedure

In the seven weeks before the procedure, Chris' symptoms got much worse. She was fine when sitting down or lying in bed. The second she started to walk, however, intense pain kicked in.

"I've always been a stoic person who doesn't like to complain," she said. "But by the time of the procedure, I was in a lot of pain. Oh, it was the worst agony I'd ever been in."

For the procedure, which took place at Brigham and Women's Hospital, Chris received conscious sedation. This meant she was relaxed and comfortable but still awake and able to respond to questions, similar to what patients experience during a colonoscopy. According to Dr. Epelboym, the procedure could not have gone more smoothly. Chris spent about six hours in recovery before her son took her home.

Upon waking up the next morning, Chris felt almost no knee pain. Two weeks later, she and a friend took a train down to New York City to see a show on Broadway. Although she had to use a cane and moved slowly, she considered the trip a success.

"We recommend that patients avoid any vigorous physical activity for two weeks to make sure the little hole we made during the procedure for inserting the catheter has healed and is sealed off," Dr. Epelboym said. "At that point, patients should be able to resume their full physical activities, with few restrictions."

Major improvement in quality of life

Six weeks after the procedure, Chris started physical therapy through the Brigham. She is eager to build up strength in her right leg and reduce or eliminate her limp.

"I have very little pain now," she said. "I'm doing physical therapy because I want to stay as active as I can as I get older. I want to play golf again and get back to walking on the beach."

According to Dr. Epelboym, about 70% of patients who have GAE experience a substantial reduction in knee pain. He added that pain relief lasts for two years in 50-60% of cases. The patient can have the procedure again if the pain eventually returns.

Count Chris among the true believers in GAE. She is thrilled about the impact it has had on her quality of life.

"I don't worry about pain anymore," she said. "I've had a great experience with GAE, and I want other people to know about it."