Genicular Artery Embolization Vs Observation for Symptomatic Knee Osteoarthritis
GRAVITY: Genicular Artery Embolization Versus Observation for the Treatment of Symptomatic Knee Osteoarthritis: a Randomized Controlled Trial
University of California, Los Angeles
100 participants
Aug 1, 2023
INTERVENTIONAL
Conditions
Summary
The purpose of this clinical trial is to determine whether genicular artery embolization (GAE) is an effective way to treat knee pain from osteoarthritis. Pain from arthritis is often due to underlying inflammation in the joint. The inflammation is associated with increased abnormal blood flow going to the specific area of pain. If the investigator can reduce the blood flow, the inflammation can be reduced and the pain can be controlled. The GAE procedure is an experimental procedure to decrease the blood flow (embolize) to the specific region of the knee that is causing the pain. This will be done by infusing microscopic spheres into the specific blood vessel (genicular artery) supplying the area of pain in the knee. This is done through a procedure which is called an angiogram, which is done entirely through a pinhole at the creased of the thigh, using twilight (conscious) sedation. The investigators have already completed an initial trial at UCLA, and shown that this procedure is safe and effective. The purpose of this new trial is to compare outcomes of people undergoing the GAE procedure to those who do not undergo the procedure. A total of 100 patients will be enrolled, and 2/3 of the patients will be randomly selected to undergo the GAE procedure. 1/3 will not undergo the procedure. This is known as a randomized trial. During the trial, all subjects will also get MRIs and fluid withdrawn from their knee joints at various timepoints in order to precisely figure out how the procedure works on a closer (microscopic) level.
Eligibility
Inclusion Criteria7
- Provided informed consent
- Age ≥ 40 years and less than 80 years
- Ineligibility for or refusal of surgical management
- Moderate-severe knee pain as determined by visual analog scale \> 5 out of 10
- Osteoarthritis based on X-ray. Kellgren-Lawrence score \> 2 based on radiograph completed within 3 months of procedure date.
- Resistant/failed conservative treatment (e.g. NSAIDS/physical therapy/steroid joint injection/ hyaluronic acid joint injection) for at least 3 months
- Able to comply with all treatments and protocol follow-up visits
Exclusion Criteria12
- Mild knee pain as determined by visual analog scale \< 5 out of 10
- OA on knee radiograph resulting in greater than 20 degree varus or valgus angulation
- Moderate loss of kidney function, define as estimated glomerular filtration rate of less than 45 mL/min.
- Significant arterial atherosclerosis that would limit selective angiography
- History of fibromyalgia, autoimmune, or inflammatory disorder
- History of any lumbar spine surgery, spine injections, or radicular pain in the extremity believed to originate from the spine
- Allergy to iodinated contrast agents
- Active Infection or malignancy
- Recent (within 12 months) or active cigarette use
- Prior total or partial knee replacement in the subject knee
- Active pregnancy
- Uncorrectable bleeding diasthesis
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Interventions
Embozene is a medical device made by Boston Scientific approved in the United States for the treatment of hypervascular tumors and arteriovenous malformations. It consists of thousands of microscopic spheres that are injected into the artery in the knee going to the region of pain. One of the causes of pain in the setting of knee arthritis is increased blood flow going to the specific area of pain. The goal of this procedure is to decrease the blood flow (embolize) to the specific region of the knee that is causing your pain. This is done by infusing Embozene particles into the specific blood vessel (genicular artery) supplying the area of pain in the knee.
Locations(1)
View Full Details on ClinicalTrials.gov
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NCT04682652