Dr. Arjun Reddy, an Interventional Radiologist and Founding Director of RIVEA Vascular Institute, discusses the rising incidence of knee osteoarthritis, its causes, and emerging treatments like Genicular Artery Embolization. He shares insights into the procedure’s benefits, risks, and comparison to knee replacement surgery. Can you explain what Interventional Radiology is? Interventional Radiology is a field that started in 1967, and it’s one of the hidden specialties of modern medicine. It involves using image guidance to treat diseases through minimally invasive procedures. We use intra-arterial and intravenous therapies, as well as percutaneous procedures, to treat various conditions without surgery. My focus is on body interventions, excluding the heart and brain. It’s a field that has evolved from the work of pioneers like Charles Theodore Dotter, who performed the first angioplasty in 1964. Why do you think osteoarthritis, particularly knee osteoarthritis, has become increasingly common in recent times? The rising incidence of knee osteoarthritis can be attributed to modern lifestyle factors, such as obesity, sedentary habits, and an inflammatory diet. These factors contribute to increased inflammation, which aggravates the condition. As a result, lifestyle modification, including diet and exercise, physiotherapy, and strengthening leg muscles, is often the first line of treatment. For patients who don’t respond, other options like pain reduction treatments are considered. Are there any new developments or emerging treatments for osteoarthritis? While the presenting complaints of osteoarthritis remain the same, there are new treatment options like genicular artery embolization and genicular nerve ablation that are showing promising outcomes. Additionally, research is ongoing to develop disease-modifying drugs that can potentially stop the progression of osteoarthritis, which is an exciting area to watch in the near future. Currently, treatments focus on managing pain, but finding ways to halt disease progression would be a significant breakthrough. Can you explain Genicular Artery Embolization and its effectiveness in relieving knee pain? Genicular artery embolization is an emerging procedure for treating knee pain, pioneered by Dr. Okuno in 2017. It involves accessing the blood vessels supplying the knee and targeting abnormal vessels that develop in osteoarthritis, which continuously supply inflammatory substances causing pain. By blocking these vessels using a temporary blocking agent, significant pain relief is achieved. Research shows 80% of patients experience 60-70% pain reduction, with relief lasting beyond 2-4 years. This procedure offers a lasting solution compared to other treatments like knee injections or pain medications, which typically provide relief for only 3 months to a year. Is Genicular Artery Embolization suitable for all age groups, especially seniors? There’s no age restriction for this procedure. It’s minimally invasive, involving just a pinhole, no surgery, and no anesthesia. This makes it ideal for older adults who may not be good candidates for surgery. The procedure takes about 45 minutes to an hour, using advanced 3D imaging to target abnormal blood vessels. With minimal risk of infection or anesthesia complications, it’s a safe option for seniors. Is Genicular Artery Embolization a painless procedure, and what is the estimated cost? It’s absolutely painless, with just a small local anesthesia given before the procedure. Patients might feel a bit of warmth in the leg during the procedure, but that’s about it. They can go back home in 3-8 hours and resume normal activities the same day. The cost is around One lakh for a leg and 1.25 to 1.5 lakhs for two legs, though it may vary depending on individual patient requirements. What are the potential risks and side effects of Genicular Artery Embolization? The procedure is generally safe, with minimal risks. There’s a small chance of hematoma at the groin site, but it’s rare and well-controlled. Some patients (2-4%) may experience skin discoloration around the knee, which is self-limiting and resolves on its own. Nerve-related complications like tingling sensations can occur in less than 0.5% of cases, but they are also temporary. If pain recurs after the procedure, patients can undergo a repeat procedure or explore other pain management options. It’s essential to note that Genicular Artery Embolization isn’t a replacement for knee replacement surgery, but rather an option for patients who want to delay surgery or aren’t good candidates for it. How does Genicular Artery Embolization compare to knee replacement surgery in terms of benefits and outcomes? Knee replacement surgery is a major procedure with a long recovery time, up to a year, and 10-20% of patients may not be satisfied with the outcome or experience ongoing pain. Genicular Artery Embolization offers a shorter-term to medium-term solution, providing pain relief for 3-4 years, making it an alternative option for patients who want to delay surgery due to age, fitness, or lifestyle concerns. While knee replacement has a higher success rate, Genicular Artery Embolization offers better outcomes compared to other knee pain treatments like injections or nerve ablation, with longer-lasting relief. It’s also beneficial for patients with recurring pain after knee replacement surgery. Can Genicular Artery Embolization help patients avoid knee surgery altogether, and is the procedure covered by insurance? While Genicular Artery Embolization can provide relief for 3-4 years, allowing patients to delay surgery, it’s not a permanent solution. Research hasn’t gone beyond 4-5 years to determine long-term outcomes. It’s beneficial for patients who want to avoid surgery due to personal or professional reasons or for those who are elderly or unfit for surgery. As for insurance coverage, corporate insurances do cover the procedure, but it’s about 50-50 between cash pay and insurance coverage in our practice, with some challenges encountered with certain insurance providers.
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