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Knee Replacement—Not Your Only Choice for Osteoarthritis?

Genicular artery embolization

Treatment for osteoarthritis of the knee in the past has tended to follow a predictable course: patients start with conservative care consisting of medication for pain and inflammation, physical therapy to try to support the failing joint, and injections to reduce symptoms and make movement easier. None of these things do more than delay the progression of pain and loss of function, so when the situation gets too bad, patients are then referred for knee replacement surgery.

Why do patients and doctors put off replacing a joint until arthritis has made simple daily tasks like getting out of a chair or walking up steps an excruciating ordeal? Because knee replacement surgery is a difficult procedure that can’t be tolerated by every patient, and which requires a lengthy recovery period. Artificial joints also wear out over time (typically 15 to 20 years), raising the possibility that a patient who has an early replacement might have to undergo surgery a second time when the new joint wears out. Given those serious drawbacks, it’s common for patients to grit their teeth and wait even as their mobility declines and pain increases.

Nowadays, though, there is a middle path that patients should consider, especially if conservative care isn’t helping and they aren’t willing or able to undergo surgery. Genicular artery embolization (GAE) is a minimally invasive procedure performed on an outpatient basis that targets the inflammation causing knee pain.

The Downsides of Knee Replacement

A knee replacement surgery removes damaged bone and cartilage and replaces it with a prosthesis to enable the joint to work normally again. Typically, the procedure accomplishes this goal, but not without an extensive period of rehabilitation and pain afterward, even when surgery is without complications.

What should you expect? Patients who leave the hospital are not able to function independently for several weeks—in fact, they’re told to prepare for a six-week recovery period. Crutches or a walker are needed to get around. Patients will also need assistance with basic tasks like bathing and household chores, so if family and friends are not available to help, a home care aide will need to be brought in at least part-time. In addition, patients won’t be able to drive until they are free of narcotic pain medication and can demonstrate that their knee bends far enough and they have the muscle strength to use the gas and brake effectively (3 weeks or more post-surgery).

Patients are usually advised to avoid climbing stairs, which may necessitate setting up a bedroom on the first floor of a multistory home. In addition, safety rails should be installed in the bathroom, and slipping or tripping hazards like loose rugs and cords should be removed. Throughout recovery, physical therapy is needed to increase the range of motion in the knee and develop leg strength.

Even if patients are willing to go through all of this, some are simply not good candidates for knee replacement due to other health issues or advanced age, either of which can increase the chance of dangerous complications. Like other major surgeries, knee replacement carries the risk of producing blood clots, infection, heart attack, stroke, and/or nerve damage. It’s no wonder it is often treated as a last resort.

Finding Another Way

Genicular artery embolization is a relatively new procedure that offers long-term relief from osteoarthritis pain in the knee. Performed by an interventional radiologist, this minimally invasive technique blocks blood flow to the synovium (lining of the knee) to permanently reduce inflammation. Unlike surgery, GAE does not require patients to be put under general anesthesia—they go home the same day and can resume normal activity the next day. Patients experience growing pain relief over several months, without physical therapy.

If conservative care isn’t helping anymore, and you’re not ready or able to undergo knee replacement surgery, GAE may be the answer that helps you get back to the activities you love without pain. Board-certified interventional radiologist Dr. Saleh has extensive experience in innovative image-guided procedures such as GAE that restore quality of life without the risks of major surgery. To find out more about GAE, or to schedule a consultation, contact the Vein & Fibroid Treatment Center here.

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