Musculoskeletal (MSK) And Sports Medicine

1. Musculoskeletal (MSK) And SportsMedicine Genicular artery embolization (GAE), or embolization of the knee, is a novel minimally-invasive procedure providing immediate and long term pain relief for patients with osteoarthritis (OA), by reducing the blood flow to the lining of the knee, known as the synovium. It is performed by an Interventional Radiologist (IR), who is a specialist physician that uses X-rays and other imaging modalities to see in the body and treat diseases withoutsurgery. Why it’sdone:. GAE blocks the blood flow to the lining of the knee, known as synovium, that are inflamed. By blocking these arteries, there is a reduction in the amount of inflammation associated with osteoarthritis, a process that can help or eliminate the associated knee pain. While further research is needed, initial trials shows the promise this technique holds for patients with debilitating knee pain who are not ready or willing to undergo knee replacement surgery. While it may not treat the underlying cartilage destruction, evidence so far shows that this may be an effective way to manage the symptoms. In an article published in the Society of Interventional Radiology in March 2021, average pain scores decreased from eight out of ten before GAE to three out of ten within the firstweek. How is GAEperformed: GAE is performed with moderate ‘twilight’ sedation as an outpatient procedure, meaning the patient will go home after the procedure. The procedure generally takes one to two hours. Our IR physicians will insert a small catheter (a thin hollow tube) into the artery of the patient’s upper thigh and, with the use of X-rays, guide the catheter to the arteries supplying the lining of the knee. Tiny particles are then injected through the catheter into these arteries, reducing the blood supply. This in turn reduces the inflammation associated with osteoarthritis, which alleviates the Pain. (Initial (left) and final (right) angiograms of the knee after embolization. A circular marker was placed at the site of pain. The reduced blood-flow at the site of pain after embolization reduced inflammation of theknees)

2. What happens after the GAEprocedure: • Patients go home the same and in most cases, relief begins to occur in two weeks, as the inflammation in the lining of the knee is reduced, relieving the knee pain associated with osteoarthritis. • Candidate forGAE: • GAE is a non-surgical treatment alternative for patients with knee pain due to osteoarthritis who have failed conservative therapy, such as anti-inflammatory medications or knee injections, and who do not wish to undergo or are ineligible for knee replacementsurgery. • The following conditions make for a good candidate forGAE: • Age: 40-80years • Moderate to severe kneepain • Osteoarthritis based on x-ray, but without bony deformity/sclerosis • Local knee tenderness • Resistant/failed conservative treatment (NSAIDS/PT/jointinjection) • Why Not(Contraindication)? • Advanced arthritis based onx-ray • Infection ormalignancy What you are to do before procedure(Preparation)? Book prior appointment if elective or get admission in causality ifemergency Lab investigation (*PT/INR, CBC, Serum Creatinine, Viral markers), CT scan and previous records. 4-6 Hoursfasting. If you are on blood thinner like Aspirin inform duringappointment. One accompanyingperson Need to sign a consent form forprocedure

3. Approx. Stay inhospital? We have very fast and competent working team (Consultant, fellow, clinical assistant, technician and ward assistant) which provide you comfortable atmosphere and ease your nerves. Usual time of stay is around 1Day. Complications Mild pain may occur after the procedure, for which analgesics will begiven. Resume towork? You can resume your work after 2-3 days if existing diseaseallows.