Rodrigo Saad Berreta, Jared Rubin, Ashwinee Manivannan, Garret Jackson, Eric Cotter, Zeeshan Kahn, Johnathon McCormick, Juan Bernardo Villarreal-Espinosa, Salvador Ayala, Nikhil N Verma, Jorge Chahla
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引用次数: 0
Abstract
Purpose: To evaluate procedural heterogeneity, patient reported outcomes (PRO), and complications following geniculate artery embolization (GAE) for knee OA.
Methods: A literature search was performed using PubMed, Embase, and Scopus databases from inception to August 2023 according to the 2020 PRISMA guidelines. Human clinical studies reporting PROs following GAE for treatment of knee OA were included and a qualitative comparison across PROs, procedural descriptions and complications was performed. Study quality was assessed using the Cochrane Collaboration's risk of bias tool and the MINORS criteria. The primary outcome measures included changes in PROs at 12 months and variances in procedural methodology.
Results: A total of 17 studies, consisting of 533 patients and 620 knees were identified. The reported mean improvement at 12 months for VAS pain and WOMAC scores ranged from 10-59 and 35.3-47, respectively. At 12 months, median improvements were observed in KOOS subscales such as Pain (range, 8.3-19.5), QOL (15.49-25.0), Sport (7.5-26.3) and Symptoms (1.8-25.0). Decreasing MCID achievement was observed between the 3 month and 6 month follow-up points. Patients with advanced OA and degenerative findings on MRI exhibited lower rates of MCID achievement. Transient adverse events occurred in up to 80% of patients. Limited evidence from serial MRI assessments suggests that GAE improves levels of synovitis. Significant heterogeneity exists among the GAE methodology as 4 different definitions of technical success, 4 distinct embolization targets and use of 5 embolization agents were noted.
Conclusion: GAE results in short-term improvements in pain and function with decreasing MCID achievement observed after 3 to 6 months. Patients with severe OA also demonstrate lower rates of MCID achievement. A high rate of transient complications are reported including skin discoloration and access site hematomas. Significant protocol heterogeneity exists which contributes to variable outcomes.
Level of evidence: IV; Systematic Review of Level IV Studies.
期刊介绍：
Nowhere is minimally invasive surgery explained better than in Arthroscopy, the leading peer-reviewed journal in the field. Every issue enables you to put into perspective the usefulness of the various emerging arthroscopic techniques. The advantages and disadvantages of these methods -- along with their applications in various situations -- are discussed in relation to their efficiency, efficacy and cost benefit. As a special incentive, paid subscribers also receive access to the journal expanded website.
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