Vascular Interventions: The New Frontier in Arthroses Treatment

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Arthrosis affects millions worldwide, causing pain and limiting mobility, with conventional treatments often providing only temporary relief. Artery embolization (AE) represents a groundbreaking approach targeting the vascular component of joint inflammation. This minimally invasive procedure blocks abnormal blood vessels feeding inflammation without affecting healthy tissue. Clinical studies show up to a 79.8% success rate with pain reduction continuing beyond two years post-procedure. With its favorable safety profile and ability to potentially delay joint replacement surgery, AE offers hope for maintaining an active lifestyle while preserving your natural joint. Learn how this innovative interventional radiology treatment is changing the landscape of arthrosis management and expanding options for patients seeking alternatives to traditional approaches.

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The Growing Challenge of Arthrosis: A Global Health Crisis

Arthrosis of large joints – shoulder, elbow, knee, hip, and ankle – represents more than just a medical diagnosis. For patients, it means persistent pain, limited mobility, inability to maintain regular physical activity, and a significant deterioration in quality of life.

The burden of arthrosis extends far beyond individual suffering. With millions affected worldwide, the economic impact through healthcare costs and lost productivity is substantial. Risk factors include age, obesity, joint injuries, genetic predisposition, and occupational stressors that place repetitive strain on joints.

Unfortunately, osteoarthrosis cannot be cured. As a medical team dedicated to finding innovative solutions, we're particularly concerned by the alarming trend of arthropathy being diagnosed at increasingly younger ages, especially among athletes and physically active individuals.

As the research shows, knee joint degeneration remains the most prevalent form, affecting approximately 13% of women and 10% of men aged 60 years and older. However, we're seeing concerning increases in all forms of joint degeneration, making the search for effective interventions more crucial than ever.

Current Treatment Landscape and Its Limitations

The conventional approach to arthrosis management typically follows a stepwise progression from conservative measures to more invasive interventions as the disease advances.

Medication management currently includes:

• NSAIDs for arthrosis pain treatment and inflammation reduction, available as oral medications or topical applications
• Corticosteroids administered orally or via joint injection to reduce inflammation
• Disease-modifying antirheumatic drugs and newer biologics for specific inflammatory arthritis types

Physical therapy approaches focus on the following:

• Exercises to improve joint range of motion
• Splints or braces for support in eligible cases
• Anti-inflammatory low-dose radiotherapy

Arthroscopic interventions include techniques like:

• Cartilage regeneration techniques: microfracture and nano-fracture
• Autologous matrix-induced chondrogenesis (AMIC)
• CartiFill three-dimensional chondroconductive collagen matrix
• Autologous chondrocyte implantation (ACI)
• Osteochondral autograft transplantation (OATS)

While these arthroscopic techniques represent significant advances, particularly for localized cartilage damage, they face limitations when addressing more widespread joint degeneration typical in moderate to advanced arthrosis.

The Shortcomings of Conservative Management Approaches

Unfortunately, conventional approaches have clear limitations. Medications offer only temporary relief while risking side effects, physical therapy cannot restore function, and even sophisticated arthroscopic techniques help only with localized damage.

The harsh reality we observe is that virtually all patients with progressive arthrosis eventually require joint replacement (endoprosthetics) when conservative measures fail. This creates a troubling scenario:

• Endoprostheses have a maximum service life of approximately 15 years, often requiring replacement after just 10 years in physically active individuals
• Only 1-2 replacement procedures are typically possible for a single joint
• This creates a critical situation for younger patients who may face joint fusion (ankylosis) and permanent immobilization in their later years if they undergo replacement too early

This underscores the crucial importance of developing interventions that can effectively postpone the need for joint replacement surgery. Every year gained before endoprosthetics represents valuable time maintaining natural joint function and preserving future options.

The Inflammatory Pathway: A New Target for Intervention

The understanding of osteoarthritis has evolved significantly over recent years. Far from being merely a "wear and tear" condition, we now recognize arthrosis as a complex inflammatory disorder with vascular components playing a crucial role in disease progression and symptom manifestation.

In osteoarthritis, abnormal blood vessels from the surrounding arteries (such as the genicular arteries in the knee) grow into the joint tissues and bone. These vessels become inflamed or compressed during joint movement, triggering pain, swelling, and progressive functional limitation.

The significance of this vascular pathway cannot be overstated. Synovitis (inflammation of the joint lining) results in a cascade of inflammatory mediators, including C-reactive protein, prostaglandins, cytokines, and growth factors. This inflammatory environment directly contributes to cartilage breakdown, joint space narrowing, and disease progression.

Artery embolization (AE) represents a novel, minimally invasive procedure for treating osteoarthritis. By targeting the inflammatory pathway directly at its vascular source, this technique addresses a fundamental mechanism of disease progression rather than merely treating symptoms. For patients seeking to postpone or potentially avoid joint replacement, AE provides a promising alternative that preserves joint integrity while addressing pain and inflammation.

What makes artery embolization uniquely valuable is its targeted approach to this specific pathogenic mechanism. Rather than broadly suppressing inflammation throughout the body (as with NSAIDs) or temporarily reducing local inflammation (as with steroid injections), AE precisely interrupts the vascular supply feeding the inflammatory process.

As our research team has observed, this approach aligns with the current understanding that osteoarthritis involves not just mechanical degradation but also active inflammatory and vascular components that can potentially be modified with targeted interventions.

Vascular Interventions: Changing the Treatment Paradigm

Artery embolization for arthrosis represents a truly revolutionary approach to joint preservation. The procedure is remarkably straightforward yet sophisticated in its targeting of disease mechanisms.

During the intervention, an interventional radiologist makes a tiny puncture, typically in the groin area, to access the arterial system. A microcatheter is navigated to the specific arteries feeding the inflamed synovium in the affected joint using specialized imaging guidance. Tiny embolic particles are then precisely delivered to block these abnormal vessels, effectively "pruning" the vascular network that sustains inflammation without affecting normal blood flow to healthy tissues.

Advanced joint imaging techniques, including arthrography with contrast (MR arthrography), allow for precise visualization of the abnormal vascular networks targeted by embolization, enhancing both diagnostic accuracy and treatment planning.

The entire procedure typically takes approximately one hour to complete, with patients discharged the same day. Follow-up evaluation occurs within a month to assess symptom improvement and monitor for any potential complications.

While the general principles remain consistent, the technique requires specific adaptations for different joints:

• Knee (Genicular Artery Embolization/GAE): targets the genicular arteries surrounding the knee joint, with particularly careful attention to sparing arterial branches that supply the skin and surrounding tissues. This approach offers the best treatment for knee osteoarthritis and effective knee joint treatment without surgery.
• Shoulder (Shoulder Artery Embolization/SAE): focuses on branches of the suprascapular, subscapular, and circumflex arteries that feed synovial inflammation, requiring precise navigation to avoid critical vascular structures in this complex joint. This procedure provides effective shoulder arthritis treatment and shoulder joint pain treatment for patients seeking relief.
• Elbow (Elbow Artery Embolization/EAE): addresses the recurrent radial and ulnar collateral arteries, with special consideration for the dense nerve network in this region. This intervention represents an innovative treatment for arthritis in elbow, targeting the specific vascular pathways that contribute to elbow arthritis pain and inflammation.
• Hip (Hip Artery Embolization/HAE): targets the articular branches of the femoral and obturator arteries, offering a new treatment option for hip osteoarthritis with promising outcomes. This approach is becoming recognized as the best treatment for osteoarthritis in hip among minimally invasive options.
• Ankle (Ankle Artery Embolization/AAE): focuses on branches of the anterior and posterior tibial arteries, providing a new ankle joint pain treatment that addresses the vascular component of inflammation in this weight-bearing joint.

As a medical team committed to advancing patient care, we must emphasize that vascular embolization for osteoarthritis is still not widely available due to the scarcity of specialists with expertise in this technique. This represents a significant challenge in the field – a shortage of physicians proficient in what we believe represents the future of osteoarthritis treatment.

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Who is a good candidate for AE?

Artery embolization offers a valuable treatment option for a wide range of patients with osteoarthritis. Based on our clinical experience and research findings, ideal candidates typically share several characteristics:

• Active individuals seeking to maintain their mobility and quality of life
• Adults aged 35 and above with established osteoarthritis
• Those experiencing moderate to severe joint pain despite conservative measures
• Individuals who have experienced little to no improvement with traditional treatments, like steroid ultrasound-guided therapy or pain medications
• Patients who are not yet candidates for joint replacement or wish to postpone this option

The technique is particularly valuable for patients who face challenging treatment decisions, including:

• Those not psychologically ready for major joint replacement surgery
• Patients considered poor surgical candidates due to comorbidities such as diabetes or obesity
• Younger patients for whom delaying joint replacement could prevent multiple revision surgeries later in life
• Individuals with "wet" osteoarthritis characterized by active synovitis and joint effusion, which respond particularly well to this vascular-targeted approach

Our clinical specialists, focused on innovative arthrosis solutions, carefully evaluate each patient's specific situation to determine if artery embolization represents an appropriate intervention in their osteoarthritis management journey.

Clinical Evidence and Patient Outcomes

The clinical evidence supporting artery embolization for osteoarthritis continues to grow, with multiple studies demonstrating encouraging results across several key outcome measures.

A prospective study of 72 patients (95 knees, including patients with indications for knee replacement) with osteoarthritis of Kellgren-Lawrence grade 1-3 showed a clinical success rate of 79.8% (95% CI, 69%-87%) three years after genicular artery embolization. Importantly, follow-up MRI for joint diagnosis at two years demonstrated significant improvement in synovitis compared to baseline (p = 0.0016) without evidence of osteonecrosis or progression of degenerative changes.

Safety profiles of this currently the best treatment for knee arthritis have been remarkably favorable, with adverse events being predominantly minor and transient. The most commonly reported side effect is temporary skin discoloration at the treatment site, which typically resolves without intervention.

What's particularly noteworthy is the progressive improvement in pain scores over time, suggesting that the benefits of embolization may continue to develop beyond the immediate post-procedure period. The research indicates that artery embolization is effective and durable in reducing pain symptoms from moderate or severe osteoarthritis that has proven refractory to other conservative therapies, all while maintaining an acceptable safety profile.

Short and Long-term Pain Relief Data

What's particularly noteworthy is the progressive improvement in pain scores over time, suggesting that the benefits of embolization may continue to develop beyond the immediate post-procedure period. The research indicates that artery embolization is effective and durable in reducing pain symptoms from moderate or severe osteoarthritis that has proven refractory to other conservative therapies, all while maintaining an acceptable safety profile.

*Based on Western Ontario and McMaster Universities Osteoarthritis Index pain score

** Data of Prof. Dr. med. Attila Kovács

Functional Improvements Across Different Joints

Beyond osteoarthritis pain reduction, functional improvements have been documented across multiple joint types following artery embolization:

Knee arthritis treatment:

• Significant improvements in walking distance and stair-climbing ability
• Reduced morning stiffness and improved ability to perform daily activities
• Enhanced participation in low-impact recreational activities

Shoulder arthritis treatment:

• In a study of 15 patients with a frozen shoulder treated with embolization, significant correlations were observed between decreased FDG uptake (a measure of inflammation) and improvements in both pain scale scores (p = 0.039) and extension capability (p = 0.026)
• Improved range of motion, particularly in external rotation and abduction
• Enhanced ability to perform overhead activities and reduced night pain
• This shoulder synovitis treatment provides a comprehensive improvement in joint function

Elbow arthritis treatment:

• Marked reduction in synovitis as demonstrated by imaging studies
• Improved grip strength and functional use of the arm
• Reduced pain with both rest and activity

Hip arthrosis management:

• The new treatment for hip osteoarthritis has demonstrated significant improvements in weight-bearing comfort and walking distance
• Reduction in pain medication requirements and improved sleep quality

Ankle arthritis treatment:

• The new ankle joint pain treatment through embolization shows particular promise in post-traumatic cases
• Improved stability and comfort during walking and standing
• Reduced pain and swelling with activity

These functional improvements translate to meaningful quality-of-life enhancements, allowing many patients to resume activities they had previously abandoned due to joint pain and limitation.

Avoiding or Delaying Joint Replacement Surgery

One of the most significant potential benefits of artery embolization is the postponement or potential avoidance of joint replacement surgery. Our follow-up studies of patients who have undergone these procedures show:

• Many patients who were previously considered candidates for imminent joint replacement have been able to delay surgery by years following embolization
• The preservation of native joint function avoids the limitations inherent to artificial joints
• Each year of postponement represents the preservation of future treatment options, particularly valuable for younger patients who might otherwise face multiple revision surgeries
• The minimally invasive nature of embolization does not "burn bridges" - patients can still pursue other treatments, including eventual joint replacement if necessary, without compromise

As a medical team committed to patient-centered care, we view this ability to preserve natural joint function and expand the timeline of hip joint endoprosthesis, knee joint endoprosthesis, and elbow endoprosthesis as perhaps the most valuable aspect of artery embolization techniques.

Comparing efficacy: Conventional vs. Novel

This comparison highlights the unique position of artery embolization in the treatment spectrum, offering substantial pain relief and functional improvement with disease-modifying potential, all through a minimally invasive therapy with durable results and minimal complications.

Genicular artery embolization vs ablation studies consistently show embolization provides longer-lasting relief with fewer side effects, making it the best way to treat persistent joint inflammation and pain. Many specialists consider artery embolization the best thing to happen in interventional joint care in recent years.

Accessing Innovative Care with Booking Health

The limited availability of innovative treatments like artery embolization creates significant barriers for patients seeking alternatives to joint replacement. At Booking Health, we've made it our mission to bridge this gap by connecting patients with the specialized expertise needed for these cutting-edge interventions, simplifying access to international medical care.

We provide comprehensive support for patients seeking innovative arthrosis treatments through a personalized approach that includes:

• Expert assessment of your case and connection to specialized facilities with experienced interventional specialists
• Development of individualized treatment programs at internationally recognized centers without foreign patient premiums
• Complete medical and logistical coordination, including documentation, appointments, and insurance coverage
• Travel support with transportation, accommodation, and interpreter services when needed
• Ongoing care management, including medication procurement and post-treatment communication with specialists

Our primary commitment is to your well-being and ensuring you receive the best medicine and most advanced care for your condition. By facilitating access to specialized interventions like artery embolization, we hope to expand your treatment possibilities and support your journey toward better joint health and quality of life.

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Authors:

This article was edited by medical experts, board-certified doctors Dr. Nadezhda Ivanisova, and Dr. Vadim Zhiliuk. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!

Our editorial policy, which details our commitment to accuracy and transparency, is available here. Click this link to review our policies.

Sources:

PubMed

The University of Chicago Medical Center

Journal of Vascular and Interventional Radiology (JVIR)

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