Review of genicular artery embolization, radiofrequency ablation, and cryoneurolysis in the management of osteoarthritis-related knee pain.

Osteoarthritis (OA) of the knee represents one of the most common diseases in the world, affecting an estimated 14 million people in the United States alone. Exercise therapy and oral pain medication are first-line treatments but have limited efficacy. Next-line treatments such as intra-articular injections are limited in durability. Moreover, total knee replacements, although effective, require surgical intervention, which has considerable variability in patient satisfaction. Novel minimally invasive image-guided interventions are becoming more widespread for treating OA-related knee pain. Recent studies of these interventions have revealed promising results, minor complications, and reasonable patient satisfaction. In this study, published manuscripts were reviewed in the field of minimally invasive, image-guided interventions for OA-related knee pain, with a focus on genicular artery embolization, radiofrequency ablation, and cryoneurolysis. Recent studies have demonstrated a significant decrease in pain-related symptoms following these interventions. Reported complications were mild in the reviewed studies. Image-guided interventions for OA-related knee pain exist as valuable options for patients who fail other therapies, may not be good surgical candidates, or wish to avoid surgical intervention. Further studies with randomization and an increased length of follow-up are needed to better characterize outcomes following these minimally invasive therapies.

Clearing the Congestion: Chest Radiography and BNP to Rule-out Congestive Heart Failure.

PURPOSE: Ruling out congestive heart failure (CHF) is clinically important in Emergency Department (ED) patients. Normal serum brain natriuretic peptide (BNP) represents an important reference standard for excluding CHF. Results of chest radiographs (CXR) are also considered and, when discordant with BNP levels, may result in a clinical dilemma. The present study was designed to elucidate factors associated with CHF on CXR in an ED cohort with normal BNP. MATERIALS AND METHODS: All adults at our urban health system's EDs who underwent CXR within 24 hours and had a normal BNP (<300 pg/mL) within 24 hours of CXR were retrospectively identified. Of these, 0.9% (8/862) had equivocal CXRs and was excluded. Demographics, comorbidities, CXR report results for CHF, and portable technique were noted. Logistic regression was used to assess factors that are associated with the presence of CHF on CXR. RESULTS: The study cohort comprised 854 patients (433 men, mean age 60.99±15.30) with normal BNP; 91.5% (781/854) had no CHF on CXR and 8.5% (73/854) had CHF. Patients with CHF on CXR had a higher body mass index (32.9 vs. 29.8 kg/m 2 , P =0.0205) were more likely to have a history of CHF or diabetes with complications (OR: 2.72 and 2.53, respectively), had higher serum BNP levels (median 164 vs. 98 pg/mL, P =4.91×10 -5 ), and underwent portable examination more frequently (86.3% vs. 57.5%, OR: 4.65). CONCLUSIONS: Normal serum BNP was concordant with CXR results, adding diagnostic confidence in ruling out CHF in a large majority of ED patients. A higher body mass index, history of CHF, and diabetes with complications and portable CXR technique were associated with CHF on CXR among the minority with normal BNP.

Genicular artery embolization as a treatment for refractory osteoarthritis related knee pain.

Genicular artery embolization (GAE) is a minimally invasive outpatient therapy for osteoarthritis (OA) related knee pain, refractory to conservative management. This intervention targets neovasculature which arises in the setting of angiogenesis in OA. Various clinical trials highlighted in this manuscript suggest that GAE is effective in durably reducing OA-related knee pain, with a limited adverse event profile. This review also explores the clinical evaluation of GAE candidates, genicular artery anatomy, technical components of the procedure, and imaging from various GAE embolizations. It also discusses future directions for research which may illuminate predictors of clinical success as well as avenues for evolution in the GAE treatment.