Advanced Interventional Procedures for Knee Osteoarthritis: What Is the Current Evidence?

Abstract

The prevalence of knee osteoarthritis (OA) is the highest among all joints and likely to increase over the coming decades. Advances in the repertoire of diagnostic capabilities of imaging and an expansion in the availability and range of image-guided interventions has led to development of more advanced interventional procedures targeting pain related to OA pain while improving the function of patients presenting with this debilitating condition. We review the spectrum of established advanced interventional procedures for knee OA, describe the techniques used to perform these procedures safely, and discuss the clinical evidence supporting each of them.

Keywords

knee - osteoarthritis - pain - cryoneurolysis - ablation

Publication History

Article published online:
20 May 2024

• References

• 1 World Health Organization. Osteoarthritis. Available at: https://www.who.int/news-room/fact-sheets/detail/osteoarthritis#:∼:text=In%202019%2C%20about%20528%20million%20people%20worldwide%20were,followed%20by%20the%20hip%20and%20the%20hand%20%282%29 Accessed February 8, 2024
• 2 GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396 (10258): 1204-1222
• 3 Long H, Liu Q, Yin H. et al. Prevalence trends of site-specific osteoarthritis from 1990 to 2019: findings from the Global Burden of Disease Study 2019. Arthritis Rheumatol 2022; 74 (07) 1172-1183
• 4 Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vos T. Global estimates of the need for rehabilitation based on the Global Burden of Disease Study 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2021; 396 (10267): 2006-2017
• 5 Imai R, Nishigami T, Kubo T. et al. Using a postoperative pain trajectory to predict pain at 1 year after total knee arthroplasty. Knee 2021; 32: 194-200
• 6 Dalili D, Isaac A, Rashidi A, Åström G, Fritz J. Image-guided sports medicine and musculoskeletal tumor interventions: a patient-centered model. Semin Musculoskelet Radiol 2020; 24 (03) 290-309
• 7 Dalili D, Isaac A, Garnon J, Cazzato RL, Gangi A. Towards personalized musculoskeletal interventional oncology: enhanced image-guided biopsies and interventions. Semin Roentgenol 2022; 57 (03) 201-211
• 8 Cazzato RL, de Rubeis G, de Marini P. et al. Interventional Radiology Outpatient Clinics (IROC): clinical impact and patient satisfaction. Cardiovasc Intervent Radiol 2021; 44 (01) 118-126
• 9 Oxford Centre for Evidence-Based Medicine. OCEBM levels of evidence. Available at: https://www.cebm.ox.ac.uk/resources/levels-of-evidence/ocebm-levels-of-evidence Accessed February 8, 2024
• 10 Sconfienza LM, Adriaensen M, Albano D. et al. Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR). Part V, knee. Eur Radiol 2022; 32 (03) 1438-1447
• 11 Sconfienza LM, Adriaensen M, Albano D. et al. Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR). Part VII, nerves of the lower limb. Eur Radiol 2022; 32 (03) 1456-1464
• 12 Dalili D, Pracoń G. Role of ultrasound in diagnostic and interventional musculoskeletal imaging. J Ultrason 2021; 21 (85) e84-e85
• 13 Sheehan B, Chevalier X. Predictors of clinical benefit with intra-articular hyaluronic acid in patients with knee osteoarthritis – a narrative review. Curr Rheumatol Rev 2024 January 18 (Epub ahead of print)
• 14 McGarry JG, Daruwalla ZJ. The efficacy, accuracy and complications of corticosteroid injections of the knee joint. Knee Surg Sports Traumatol Arthrosc 2011; 19 (10) 1649-1654
• 15 Park KD, Ahn JK, Lee SC, Lee J, Kim J, Park Y. Comparison of ultrasound-guided intra-articular injections by long axis in plane approach on three different sites of the knee. Am J Phys Med Rehabil 2013; 92 (11) 990-998
• 16 Jang SH, Lee SC, Lee JH, Nam SH, Cho KR, Park Y. Comparison of ultrasound (US)-guided intra-articular injections by in-plain and out-of-plain on medial portal of the knee. Rheumatol Int 2013; 33 (08) 1951-1959
• 17 Sibbitt Jr WL, Band PA, Kettwich LG, Chavez-Chiang NR, Delea SL, Bankhurst AD. A randomized controlled trial evaluating the cost-effectiveness of sonographic guidance for intra-articular injection of the osteoarthritic knee. J Clin Rheumatol 2011; 17 (08) 409-415
• 18 Kianmehr N, Hasanzadeh A, Naderi F, Khajoei S, Haghighi A. A randomized blinded comparative study of clinical response to surface anatomy guided injection versus sonography guided injection of hyaloronic acid in patients with primary knee osteoarthritis. Int J Rheum Dis 2018; 21 (01) 134-139
• 19 Lundstrom ZT, Sytsma TT, Greenlund LS. Rethinking viscosupplementation: ultrasound- versus landmark-guided injection for knee osteoarthritis. J Ultrasound Med 2020; 39 (01) 113-117
• 20 Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet 2010; 376 (9754): 1751-1767
• 21 Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open 2012; 2 (01) e000435
• 22 Swisher MW, Ball ST, Gonzales FB, Cidambi KR, Trescot AM, Ilfeld BM. A randomized controlled pilot study using ultrasound-guided percutaneous cryoneurolysis of the infrapatellar branch of the saphenous nerve for analgesia following total knee arthroplasty. Pain Ther 2022; 11 (04) 1299-1307
• 23 Radnovich R, Scott D, Patel AT. et al. Cryoneurolysis to treat the pain and symptoms of knee osteoarthritis: a multicenter, randomized, double-blind, sham-controlled trial. Osteoarthritis Cartilage 2017; 25 (08) 1247-1256
• 24 Dalili D, Isaac A, Bazzocchi A. et al. Interventional techniques for bone and musculoskeletal soft tissue tumors: current practices and future directions. Part I, ablation. Semin Musculoskelet Radiol 2020; 24 (06) 692-709
• 25 Nygaard NB, Koch-Jensen C, Vægter HB, Wedderkopp N, Blichfeldt-Eckhardt M, Gram B. Cryoneurolysis for the management of chronic pain in patients with knee osteoarthritis; a double-blinded randomized controlled sham trial. BMC Musculoskelet Disord 2021; 22 (01) 228
• 26 Lund J, Jenstrup MT, Jaeger P, Sørensen AM, Dahl JB. Continuous adductor-canal-blockade for adjuvant post-operative analgesia after major knee surgery: preliminary results. Acta Anaesthesiol Scand 2011; 55 (01) 14-19
• 27 Hirasawa Y, Okajima S, Ohta M, Tokioka T. Nerve distribution to the human knee joint: anatomical and immunohistochemical study. Int Orthop 2000; 24 (01) 1-4
• 28 Cedeno DL, Vallejo A, Kelley CA, Tilley DM, Kumar N. Comparisons of lesion volumes and shapes produced by a radiofrequency system with a cooled, a protruding, or a monopolar probe. Pain Physician 2017; 20 (06) E915-E922
• 29 Kapural L, Minerali A, Sanders M, Matea M, Dua S. Cooled radiofrequency ablation provides prolonged pain relief compared to traditional radiofrequency ablation: a real-world, large retrospective clinical comparison from a single practice. J Pain Res 2022; 15: 2577-2586
• 30 Ghai B, Kumar M, Makkar JK, Goni V. Comparison of ultrasound guided pulsed radiofrequency of genicular nerve with local anesthetic and steroid block for management of osteoarthritis knee pain. Korean J Pain 2022; 35 (02) 183-190
• 31 Dalili D, Isaac A, Fayad LM, Ahlawat S. Routine knee MRI: how common are peripheral nerve abnormalities, and why does it matter?. Skeletal Radiol 2021; 50 (02) 321-332
• 32 Ikeuchi M, Ushida T, Izumi M, Tani T. Percutaneous radiofrequency treatment for refractory anteromedial pain of osteoarthritic knees. Pain Med 2011; 12 (04) 546-551
• 33 Hunter C, Davis T, Loudermilk E, Kapural L, DePalma M. Cooled radiofrequency ablation treatment of the genicular nerves in the treatment of osteoarthritic knee pain: 18- and 24-month results. Pain Pract 2020; 20 (03) 238-246
• 34 Choi WJ, Hwang SJ, Song JG. et al. Radiofrequency treatment relieves chronic knee osteoarthritis pain: a double-blind randomized controlled trial. Pain 2011; 152 (03) 481-487
• 35 Davis T, Loudermilk E, DePalma M. et al. Prospective, multicenter, randomized, crossover clinical trial comparing the safety and effectiveness of cooled radiofrequency ablation with corticosteroid injection in the management of knee pain from osteoarthritis. Reg Anesth Pain Med 2018; 43 (01) 84-91
• 36 Chen AF, Khalouf F, Zora K. et al. Cooled radiofrequency ablation compared with a single injection of hyaluronic acid for chronic knee pain: a multicenter, randomized clinical trial demonstrating greater efficacy and equivalent safety for cooled radiofrequency ablation. J Bone Joint Surg Am 2020; 102 (17) 1501-1510
• 37 Fonkoué L, Behets C, Kouassi JK. et al. Distribution of sensory nerves supplying the knee joint capsule and implications for genicular blockade and radiofrequency ablation: an anatomical study. Surg Radiol Anat 2019; 41 (12) 1461-1471
• 38 Jamison DE, Cohen SP. Radiofrequency techniques to treat chronic knee pain: a comprehensive review of anatomy, effectiveness, treatment parameters, and patient selection. J Pain Res 2018; 11: 1879-1888
• 39 Tran J, Peng PWH, Gofeld M, Chan V, Agur AMR. Anatomical study of the innervation of posterior knee joint capsule: implication for image-guided intervention. Reg Anesth Pain Med 2019; 44 (02) 234-238
• 40 McCormick ZL, Reddy R, Korn M. et al. A prospective randomized trial of prognostic genicular nerve blocks to determine the predictive value for the outcome of cooled radiofrequency ablation for chronic knee pain due to osteoarthritis. Pain Med 2018; 19 (08) 1628-1638
• 41 Roos EM, Toksvig-Larsen S. Knee injury and Osteoarthritis Outcome Score (KOOS)—validation and comparison to the WOMAC in total knee replacement. Health Qual Life Outcomes 2003; 1: 17
• 42 Abd-Elsayed A. Wireless peripheral nerve stimulation for treatment of peripheral neuralgias. Neuromodulation 2020; 23 (06) 827-830
• 43 Lin CP, Chang KV, Wu WT, Özçakar L. Ultrasound-guided peripheral nerve stimulation for knee pain: a mini-review of the neuroanatomy and the evidence from clinical studies. Pain Med 2020; 21 (Suppl. 01) S56-S63
• 44 Ilfeld BM, Grant SA, Gilmore CA. et al. Neurostimulation for postsurgical analgesia: a novel system enabling ultrasound-guided percutaneous peripheral nerve stimulation. Pain Pract 2017; 17 (07) 892-901
• 45 Hasoon J, Chitneni A, Urits I, Viswanath O, Kaye AD. Peripheral stimulation of the saphenous and superior lateral genicular nerves for chronic knee pain. Cureus 2021; 13 (04) e14753
• 46 Cazzato RL, Garnon J, Koch G. et al. Musculoskeletal interventional oncology: current and future practices. Br J Radiol 2020; 93 (1115): 20200465
• 47 Dalili D, Ahlawat S, Rashidi A, Belzberg AJ, Fritz J. Cryoanalgesia of the anterior femoral cutaneous nerve (AFCN) for the treatment of neuropathy-mediated anterior thigh pain: anatomy and technical description. Skeletal Radiol 2021; 50 (06) 1227-1236
• 48 Melzack R, Wall PD. Pain mechanisms: a new theory. Science 1965; 150 (3699): 971-979
• 49 Finch P, Price L, Drummond P. High-frequency (10 kHz) electrical stimulation of peripheral nerves for treating chronic pain: a double-blind trial of presence vs absence of stimulation. Neuromodulation 2019; 22 (05) 529-536
• 50 Ilfeld BM, Ball ST, Gabriel RA. et al. A feasibility study of percutaneous peripheral nerve stimulation for the treatment of postoperative pain following total knee arthroplasty. Neuromodulation 2019; 22 (05) 653-660
• 51 Dağıstan G, Gönüllü E. Ultrasound vs. fluoroscopic guidance in genicular nerve radiofrequency thermocoagulation for chronic knee pain: which one is the future?. Eur Rev Med Pharmacol Sci 2023; 27 (15) 7073-7080
• 52 Cornman-Homonoff J, Kishore SA, Waddell BS. et al. Genicular artery embolization for refractory hemarthrosis following total knee arthroplasty: technique, safety, efficacy, and patient-reported outcomes. J Vasc Interv Radiol 2021; 32 (08) 1128-1135
• 53 Okuno Y, Matsumura N, Oguro S. Transcatheter arterial embolization using imipenem/cilastatin sodium for tendinopathy and enthesopathy refractory to nonsurgical management. J Vasc Interv Radiol 2013; 24 (06) 787-792
• 54 Okuno Y, Oguro S, Iwamoto W, Miyamoto T, Ikegami H, Matsumura N. Short-term results of transcatheter arterial embolization for abnormal neovessels in patients with adhesive capsulitis: a pilot study. J Shoulder Elbow Surg 2014; 23 (09) e199-e206
• 55 Okuno Y, Korchi AM, Shinjo T, Kato S. Transcatheter arterial embolization as a treatment for medial knee pain in patients with mild to moderate osteoarthritis. Cardiovasc Intervent Radiol 2015; 38 (02) 336-343
• 56 Bonnet CS, Walsh DA. Osteoarthritis, angiogenesis and inflammation. Rheumatology (Oxford) 2005; 44 (01) 7-16
• 57 Walsh DA, Bonnet CS, Turner EL, Wilson D, Situ M, McWilliams DF. Angiogenesis in the synovium and at the osteochondral junction in osteoarthritis. Osteoarthritis Cartilage 2007; 15 (07) 743-751
• 58 Suri S, Gill SE, Massena de Camin S, Wilson D, McWilliams DF, Walsh DA. Neurovascular invasion at the osteochondral junction and in osteophytes in osteoarthritis. Ann Rheum Dis 2007; 66 (11) 1423-1428
• 59 Ashraf S, Mapp PI, Walsh DA. Contributions of angiogenesis to inflammation, joint damage, and pain in a rat model of osteoarthritis. Arthritis Rheum 2011; 63 (09) 2700-2710
• 60 Ro DH, Jang MJ, Koh J. et al. Mechanism of action of genicular artery embolization in a rabbit model of knee osteoarthritis. Eur Radiol 2023; 33 (01) 125-134
• 61 Sajan A, Lerner J, Kasimcan MO. et al. Feasibility and technique of retrograde pedal access for genicular artery embolization. J Vasc Interv Radiol 2023; 34 (11) 2030-2033
• 62 Little MW, Gibson M, Briggs J. et al. Genicular artEry embolizatioN in patiEnts with oSteoarthrItiS of the Knee (GENESIS) using permanent microspheres: interim analysis. Cardiovasc Intervent Radiol 2021; 44 (06) 931-940
• 63 Padia SA, Genshaft S, Blumstein G. et al. Genicular artery embolization for the treatment of symptomatic knee osteoarthritis. JBJS Open Access 2021; 6 (04) e21.00085
• 64 Cusumano LR, Callese TE, Redwood K. et al. Added value of cone-beam CT to identify arterial supply during genicular artery embolization for knee osteoarthritis. J Vasc Interv Radiol 2023; 34 (11) 1861-1867
• 65 Okuno Y, Korchi AM, Shinjo T, Kato S, Kaneko T. Midterm clinical outcomes and MR imaging changes after transcatheter arterial embolization as a treatment for mild to moderate radiographic knee osteoarthritis resistant to conservative treatment. J Vasc Interv Radiol 2017; 28 (07) 995-1002
• 66 Koucheki R, Dowling KI, Patel NR, Matsuura N, Mafeld S. Characteristics of imipenem/cilastatin: considerations for musculoskeletal embolotherapy. J Vasc Interv Radiol 2021; 32 (07) 1040-1043.e1
• 67 Bagla S, Piechowiak R, Sajan A, Orlando J, Hartman T, Isaacson A. Multicenter randomized sham controlled study of genicular artery embolization for knee pain secondary to osteoarthritis. J Vasc Interv Radiol 2022; 33 (01) 2-10.e2
• 68 Bhatia S, Jalaeian H, Kumar J. et al. Two-year outcomes comparing Embosphere® microspheres versus imipenem cilastatin for genicular artery embolization in patients with moderate to severe knee osteoarthritis. Knee 2023; 41: 38-47
• 69 Bagla S, Piechowiak R, Hartman T, Orlando J, Del Gaizo D, Isaacson A. Genicular artery embolization for the treatment of knee pain secondary to osteoarthritis. J Vasc Interv Radiol 2020; 31 (07) 1096-1102
• 70 Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 1988; 15 (12) 1833-1840
• 71 Peterfy CG, Guermazi A, Zaim S. et al. Whole-Organ Magnetic Resonance Imaging Score (WORMS) of the knee in osteoarthritis. Osteoarthritis Cartilage 2004; 12 (03) 177-190
• 72 Hmamouchi I, Allali F, Tahiri L. et al. Clinically important improvement in the WOMAC and predictor factors for response to non-specific non-steroidal anti-inflammatory drugs in osteoarthritic patients: a prospective study. BMC Res Notes 2012; 5: 58
• 73 Tubach F, Ravaud P, Baron G. et al. Evaluation of clinically relevant changes in patient reported outcomes in knee and hip osteoarthritis: the minimal clinically important improvement. Ann Rheum Dis 2005; 64 (01) 29-33
• 74 Taslakian B, Miller LE, Mabud TS. et al. Genicular artery embolization for treatment of knee osteoarthritis pain: systematic review and meta-analysis. Osteoarthr Cartil Open 2023; 5 (02) 100342
• 75 Wartolowska KA, Feakins BG, Collins GS. et al. The magnitude and temporal changes of response in the placebo arm of surgical randomized controlled trials: a systematic review and meta-analysis. Trials 2016; 17 (01) 589
• 76 Landers S, Hely R, Hely A. et al Genicular artery embolization for early-stage knee osteoarthritis: results from a triple-blind single-centre randomized controlled trial. Bone Jt Open 2023; 4 (03) 158-167
• 77 Taslakian B, Swilling D, Attur M. et al. Genicular artery embolization for treatment of knee osteoarthritis: interim analysis of a prospective pilot trial including effect on serum osteoarthritis-associated biomarkers. J Vasc Interv Radiol 2023; 34 (12) 2180-2189.e3
• 78 Chau Y, Roux C, Gonzalez JF. et al. Effectiveness of geniculate artery embolization for chronic pain after total knee replacement—a pilot study. J Vasc Interv Radiol 2023; 34 (10) 1725-1733