Excess weight and aging can lead to degenerative issues in the knees. These problems are commonly seen in individuals in middle and advanced age groups. Among treatment options, medication is commonly used to alleviate pain. However, in some cases, medications may be insufficient.
At this point, a method called embolization comes into play. This procedure reduces knee pain by regulating blood flow and deactivating nerve endings. Patients typically experience a quick recovery after the procedure and enjoy long-term relief. This method is also effective in treating pain caused by shoulder osteoarthritis.
| Disease Name | Osteoarthritis |
| Other Names | Degenerative joint disease, Arthrosis |
| Affected Areas | Knees, hips, hands, spine |
| Causes | Aging, joint injuries, excess weight, genetic predisposition, excessive use of joints |
| Symptoms | Joint pain, joint stiffness, limited mobility, joint swelling, bone spurs around the joint (osteophytes), joint sounds (crepitus) |
| Diagnosis Methods | Physical examination, patient history, X-ray, magnetic resonance imaging (MRI), joint fluid analysis |
| Treatment Options | Lifestyle changes (diet, exercise), pain relievers (NSAIDs), physical therapy, corticosteroid injections, joint-protective medications, embolization, surgical intervention |
| Complications | Limited mobility, joint deformities, chronic pain, loss of working capacity |
| Prevention Methods | Regular exercise, healthy weight management, avoiding joint injuries, balanced nutrition, proper footwear selection |
| Epidemiology | Usually seen in individuals over 45 years old, more common in women, one of the most common joint diseases worldwide |
Interventional Radiology / Interventional Neuroradiology
Prof. Dr. Özgür KILIÇKESMEZ
What is Osteoarthritis?
Osteoarthritis is a chronic and progressive joint disorder. This condition, known for the gradual wear of joint cartilage, leads to pain and stiffness in the joint. The progression of the disease is usually slow but involves continuous degradation. This degradation is characterized by thinning and wear of the cartilage in the joints. The thinned cartilage increases friction between the bones, causing pain.
- Risk Factors: Aging, genetic predisposition, obesity, and excessive use of joints, along with trauma, play a significant role in the development of osteoarthritis.
These changes in the joint are most noticeable in the morning or after a long period of inactivity and are marked by stiffness. Pain increases as the joint is used and may become chronic over time. The friction and pain in the joint negatively affect the individual’s daily activities and mobility.
- Affected Areas: The most commonly affected areas are the knees, hips, and hands.
Treatment methods vary depending on the severity of the disease and the degree to which it affects the patient’s quality of life. Medications and physical therapy are commonly used to control pain and support joint functions. Additionally, regular exercise and a proper diet are crucial factors in maintaining joint health and slowing the progression of the disease.
As a result, osteoarthritis is a condition that leads to pain, stiffness, and loss of function in the joint due to the gradual degradation of the cartilage. Treatment aims to control symptoms and increase patient comfort.
Stages of Osteoarthritis: Critical Processes in Knee Health
Osteoarthritis is a common disease affecting joint health, and it is usually examined in four stages. Each stage represents the severity of the disease and the extent of cartilage damage.
- Early Stage (Mild): In this initial stage, slight wear begins on the surface of the joint cartilage. Symptoms are usually not significant, and X-rays may show minimal changes in the joint. This stage indicates mild joint degradation and thickened bone tissue.
- Middle Stage (Moderate): Cartilage degradation becomes more evident. Symptoms such as pain and stiffness begin to manifest. Decreases in mobility may occur. X-rays reveal increased friction between bones and the formation of spurs.
- Advanced Stage (Severe): Cartilage is significantly damaged and worn. Pain, stiffness, and mobility restrictions increase. X-ray images show narrowing of the joint space and more prominent bone spurs.
- Final Stage (Extremely Severe): Cartilage is almost completely lost, and pain and stiffness reach their highest levels. Joint deformities and severe mobility restrictions occur. X-ray findings reveal advanced joint deformities.
These stages are important for observing the progression of the disease and determining appropriate treatment methods. Each stage of osteoarthritis can significantly affect the patient’s quality of life and requires intervention.
Synovial Membrane Thickening and Growth in Osteoarthritis
With the progression of osteoarthritis, the synovial membrane covering the joint surfaces thickens and grows. This process aims to reduce friction and wear in the joint. The synovial membrane produces joint fluid, which helps the joint function more smoothly. As the disease worsens, the hypertrophic reaction of the synovial membrane causes the following changes:
- Increased joint fluid production,
- Fluid accumulation in the joint cavity, leading to joint swelling,
- Increased stiffness and pain in joint movements.
These situations are more frequently observed during periods of noticeable joint wear and tear. The thickening of the synovial membrane occurs as part of the joint’s protective mechanism. Therefore, thickening of the synovial membrane is a natural response in osteoarthritis, and this structural change should be considered during treatment.
Treatment of Knee Pain Due to Osteoarthritis
Various treatment options are available:
- Initially, pain control is attempted with medications. These medications typically reduce inflammation and alleviate pain.
- Physical therapy methods are also important. These methods aim to increase joint mobility and strengthen the muscles.
- Hyaluronic acid injections into the joint are also used to reduce pain. These injections increase the viscosity of the joint fluid, allowing for smoother movement.
- In stages 1-3 of osteoarthritis, 3 doses of PRP or a single stem cell injection into the joint are used to reduce pain and partially improve cartilage and meniscus healing. These injections also increase the viscosity of the joint fluid, allowing for smoother movement.
In conclusion, these methods provide a holistic approach to treating osteoarthritis. The treatment options aim to reduce pain in the knees and increase joint mobility, allowing patients to continue with their daily lives comfortably.
Non-Surgical Treatment of Knee Pain: Genicular Artery Embolization
Knee osteoarthritis, particularly common in older individuals, is a prevalent health issue. Genicular artery embolization is a non-surgical method developed to alleviate pain associated with this condition. During the procedure, a catheter is inserted through the groin to reach the arteries supplying the knee joint. Embolic agents are injected into these vessels to restrict blood flow. Through this procedure:
- It is an excellent option for patients with severe knee pain.
- Pain reduction is achieved,
- Improvements in joint function are observed.
- The goal is to reduce non-infectious inflammation in the knee and decrease the blood supply to pain-carrying nerves.
- There have been no harmful effects reported in long-term follow-ups.
- In stage 4, the effect duration is shorter,
- Should not be applied in cases of rheumatic diseases.
The treatment takes approximately 30 to 60 minutes, and patients are typically discharged on the same day. Pain significantly decreases within the first two weeks after the procedure. However, the effectiveness of the treatment may vary depending on the extent of the disease and the patient’s overall health. Regular follow-ups are important to reduce the risk of pain recurrence.
Reducing Knee Pain with Genicular Artery Embolization
Genicular artery embolization plays an important role in reducing pain associated with knee osteoarthritis. In this process, excessive blood flow and inflammation in the knee are targeted. Excessive blood flow in the knee is often a result of synovial hypertrophy. The synovial membrane and surrounding soft tissues swell due to inflammation, causing pain. This is where embolization comes in:
- Excessive blood flow triggers the development of new blood vessels and sensory nerves.
- These new blood vessels and nerves increase the sensation of pain in the knee.
- The embolization procedure cuts off this excessive blood flow, preventing the development of new blood vessels and nerves.
- As a result, inflammation decreases, and the pain sensation in the knee significantly improves.
With this method, patients experience long-term relief. The procedure is completed in a short time, and patients can usually be discharged the same day. The effect of the treatment begins in the first week after the procedure and continues for months.
Who Performs Genicular Artery Embolization?
Knee pain embolization is performed by interventional radiology specialists. This treatment is a minimally invasive procedure that utilizes imaging techniques. Specialists work with great care in diagnosing and treating diseases. The most appropriate treatment method is determined according to the patient’s condition during the procedure. All necessary details are carefully examined to ensure the successful completion of the procedure.
Special skills possessed by interventional radiologists:
- In-depth knowledge of advanced imaging techniques
- Expertise in disease diagnosis and management
- Ability to perform minimal invasive procedures with precision
These specialists provide the necessary treatment to ensure faster recovery for patients.
Reliability and Effectiveness of Genicular Artery Embolization
The treatment protocols and safety measures applied during the procedure are carefully followed to protect the health of patients. The success of the treatment may vary depending on the patient’s health condition.
Safety:
- Serious complications are rare.
- Potential risks include infection, bleeding, and vessel damage.
- Allergic reactions and embolism-related complications are very rare.
Effectiveness:
- Significant reduction in knee pain is achieved in most patients.
- Improvement in quality of life is observed.
- Pain reduction and relief duration vary by individual.
- Reduced pain also decreases movement restrictions.
The treatment results improve over time, and follow-up periods are essential for ensuring the continuity of its effect. During this period, the positive impact on patients’ pain levels and overall health becomes evident.
When Will the Effect of the Treatment Be Seen?
The recovery process after knee pain embolization can vary from patient to patient, but general trends emerge within a certain timeframe. After the procedure, some patients feel relief within hours, while the positive results are mostly observed during the following periods:
- The effect of the treatment begins to be felt starting from the first 3 days.
- Pain reduction and improved mobility are typically noticeable between 3 to 14 days.
- The maximum effectiveness of the treatment may take 1 to 4 months.
During this time, the chances of living pain-free increase, and this condition may last for years. After the treatment, the patient notices reduced pain and improved ability to perform daily activities.
What Are the Next Steps if There Is Insufficient Improvement After Knee Pain Embolization?
If sufficient improvement is not achieved after knee pain embolization, several alternative treatment options come into play. First, the embolization procedure may be repeated. This process aims to control pain by re-blocking the vessels. If repeated embolization is not sufficient, additional treatments can be started:
- Steroid or hyaluronic acid injections into the joint can be applied.
- More extensive surgical interventions, such as knee replacement surgery, may be performed.
These steps aim to improve the patient’s quality of life and provide an opportunity to live pain-free.
What Are the Possible Side Effects of Embolization for Knee Pain?
Knee pain embolization rarely causes serious complications. However, some mild side effects may occur during the treatment process. After the procedure, patients may typically experience the following symptoms:
- Temporary pain at the treatment site. This pain generally decreases and disappears within a few days.
- Skin discoloration may be observed. Additionally, mild swelling at the treatment site may occur. These symptoms usually resolve quickly.
- In rare cases, infection at the treatment site may develop.
- There is a possibility of an allergic reaction to the materials used.
Most of these side effects can be managed with proper intervention and follow-up. Any symptoms after embolization should be evaluated by a doctor, and necessary precautions should be taken.
What Are the Advantages of Embolization Treatment?
The advantages of knee pain embolization treatment are highly appealing for patients. First, this method eliminates the need for constant use of strong painkillers. Patients no longer have to deal with the side effects of continuous medication. Additionally, joint injections become unnecessary, making the treatment process less invasive.
- Rapid and long-lasting improvement in moderate to advanced pain levels.
- Significant improvement in quality of life.
- Faster return to normal daily activities compared to other methods.
Additional Resources and Documents
Prof. Dr. Özgür Kılıçkesmez graduated from Cerrahpaşa Medical Faculty in 1997. He completed his specialization at Istanbul Education and Research Hospital. He received training in interventional radiology and oncology in London. He founded the interventional radiology department at Istanbul Çam and Sakura City Hospital and became a professor in 2020. He holds many international awards and certificates, has over 150 scientific publications, and has been cited more than 1500 times. He is currently working at Medicana Ataköy Hospital.
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