25dkou60910.3205/25dkou609urn:nbn:de:0183-25dkou6094Meeting AbstractManaging chronic pain after total knee arthroplasty: The role of genicular artery embolization for unexplained painful TKA within a comprehensive rule-out algorithmPaolucciPaolucciAzzurraACenter for Musculoskeletal Surgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, DeutschlandIstituto Ortopedico Rizzoli, Bologna – Università degli Studi “Alma Mater Studiorum” di Bologna, Bologna, ItalienauthorFleckensteinFleckensteinFlorianFDepartment of Diagnostic and Interventional Radiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, DeutschlandauthorGebauerGebauerBernhardBDepartment of Diagnostic and Interventional Radiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, DeutschlandauthorMödl Mödl LukasLInstitute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, Berlin, DeutschlandauthorMaleitzkeMaleitzkeTazioTCenter for Musculoskeletal Surgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, DeutschlandJulius Wolff Institute, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, DeutschlandauthorOehmeOehmeStephanSCenter for Musculoskeletal Surgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, DeutschlandauthorCollettiniCollettiniFedericoFDepartment of Diagnostic and Interventional Radiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, DeutschlandauthorPerkaPerkaCarstenCauthorWinklerWinklerTobiasTCenter for Musculoskeletal Surgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, DeutschlandJulius Wolff Institute, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, DeutschlandBerlin Institute of Health Center for Regenerative Therapies, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, DeutschlandauthorGerman Medical Science GMS Publishing House
Düsseldorf
61020251031englThis is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License.Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung).M0634609Deutsche Gesellschaft für Orthopädie und UnfallchirurgieDeutsche Gesellschaft für Orthopädie und Orthopädische ChirurgieDeutsche Gesellschaft für UnfallchirurgieBerufsverband für Orthopädie und UnfallchirurgieDeutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2025)Abstracts | AG Evidenzbasierte Medizin | Gelenkersatz – perioperative VersorgungBerlin2025102820251031AB97-4437TextObjectives and questions: More than 3.5 million Total Knee Replacements (TKA) are performed annually worldwide, yet approximately 20% of patients continue to experience persistent pain after surgery, with 10% of this pain remaining unexplained. Diagnosing the source of pain in TKA is complex and therapeutic options for unexplained pain are very limited, leading to significant consequences on patients quality of life. Purpose of this study is to evaluate the safety and efficacy of hypervascular Genicular Arteries Embolization (GAE) in reducing chronic pain after TKA. Moreover, this study aims to present a defined diagnostic-therapeutic Rule-out Algorithm for painful TKA in order to select optimal candidates for genicular arterial embolization.Material and methods: This prospective, single-center pilot study included 28 patients with persistent pain after TKA. All patients were selected after completing a diagnostic rule-out algorithm for other potential causes of pain, thus being classified as having unexplained painful prostheses. Embolization was performed using temporary particles targeting hypervascular regions identified via angiography. Outcomes were assessed at baseline, six weeks, three, six, and twelve months post-procedure using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Patient-Reported Outcomes Measurement Information System (PROMIS). Adverse events were recorded throughout follow-up.Results: An average of 2.2 ± 0.9 abnormal hyperemic genicular arteries were embolized, with a median volume of 2.6 mL of embolic material used. KOOS Pain scores improved from 39 ± 13 at baseline to 56 ± 25 at six months (P < .05). PROMIS Pain Interference scores decreased from 65 ± 18 to 41 ± 10 at six months (P < .05). KOOS Quality of Life scores improved in 79% of patients at 12 months. Transient skin discoloration occurred in 5 patients (18%). Discussion and conclusions: Preliminary findings suggest that GAE is a safe and potentially effective treatment for managing chronic unexplained pain after TKA. Moreover, the study highlights the integration of GAE into a diagnostic-therapeutic algorithm for post-TKA pain. Further research with larger, randomized cohorts is recommended to confirm these findings.Figure 1 011
Figure 1: Diagnostic-therapeutic Algorithm for post-TKA pain