Description
Objectives: Ostheoarthritis (OA) is characterized by a chronic cycle of biochemical damage (degeneration of hyaline cartilage, periarticular tissues, and subchondral bone), angiogenesis, synovial inflammation, cartilage breakdown, and sensory neoinnervation. Proinflammatory cytokines such as TNF-α, IL-1β, and IL-6 are released and tissue repair attempts, lead to angiogenesis from preexisting vasculature. Alongside the formation of new vessels, sensory nerves grow in normal periarticular structures, contributing to pain and structural damage progression, similar to inflammatory cells. Hence, transarterial embolization of pathological vessels has been proposed as a treatment. Complications of this minimally invasive procedure are infrequent and include hematoma at the puncture site and embolization at an incorrect point, leading to potential bone infarction or transient numbness.
The aim of this study was to report our results using this procedure in chronic knee pain.
Methods: At our hospital, recent transarterial embolizations with imipenem-cilastatin via the contralateral femoral artery: was performed on five patients. Three of the patients had a OA diagnosis and 2 of them hemartrosis some years after total knee arthroplasty.
Results: Results reported after the procedure were good, only one patient had persistent pain and the only complication reported was a skin rash alergic reaction treated with topical corticosteroids.
Conclusions: Embolization could be considered a part of osteoarthritis treatment, as described in published articles, given its pathophysiological basis.
In our case series, the embolized patients showed positive outcomes with minor, transient complications. In OA patients, they improved in terms of relief of popliteal fossa pain (which was predominant). Based on angiography, the embolized vessels were the geniculate arteries or their branches.
The other uses of embolization with imipenem-cilastatin crystals in increased vascularization or vascular malformations or fistulas also improved with immediate resolution of symptoms
Further investigations assessing such shortcomings will help elucidate the clinical indications and efficacy of imipenem-cilastatin crystals embolization. Long-term follow-up is needed for all patients.
