Summary
Introduction. Osteoarthritis is a significant cause of disability worldwide. While most of the mild cases respond to conservative treatment and severe cases require surgery, managing mild to moderate osteoarthritis resistant to conservative treatment remains challenging. Genicular artery embolization has emerged as a promising treatment option for these patients. However, optimal patient selection remains unclear, emphasizing the need for advanced imaging techniques to refine selection criteria.
Case report. We present the case of a 54-year-old male with moderate knee osteoarthritis, classified as Kellgren– Lawrence grade 2, who underwent genicular artery embolization after failing conservative treatment. Pre-procedural assessment included dynamic contrast-enhanced magnetic resonance imaging to evaluate synovial inflammation and vascularity. Significant symptom improvement was observed following genicular artery embolization, with total WOMAC scores decreasing by approximately 30% at three months and 65% at twelve months, while the VAS score dropped from 7 to 1 over the same period. Magnetic resonance imaging findings demonstrated reduced synovial enhancement, indicating decreased inflammation.
Discussion. Optimal genicular artery embolization outcomes depend on careful patient selection, with mild to moderate osteoarthritis responding best, while severe cases have a higher risk of pain recurrence. Standard magnetic resonance imaging may be insufficient for identifying ideal candidates, as no reliable imaging predictors have yet been established to reliably predict better outcomes. Dynamic contrast-enhanced magnetic resonance imaging provides a detailed assessment of synovial inflammation, with perfusion-related variables serving as surrogate markers of inflammation. Given these advantages, it holds significant potential for improving patient selection and treatment outcomes.
Conclusions. This case highlights the potential of dynamic contrast-enhanced magnetic resonance imaging in guiding patient selection for genicular artery embolization. Further research is required to validate imaging-based selection criteria and improve treatment outcomes.
