Genicular Artery Embolization with Moutasem Aljundi, MD

Chronic knee pain affects millions of Americans, especially as we age, and osteoarthritis is often the cause. In this episode, host Debra Schindler talks with Dr. Moutasem Aljundi, vascular and interventional radiologist at MedStar Health, to explore an emerging, minimally invasive treatment option you may not have heard of: genicular artery embolization (GAE).

Dr. Aljundi explains how GAE works by reducing abnormal blood flow that fuels inflammation inside the knee joint, helping relieve pain and stiffness caused by osteoarthritis. The conversation covers who may be a good candidate, how the outpatient procedure is performed, recovery time, success rates, and how GAE compares to other treatments like steroid injections, nerve ablation, and knee replacement surgery.

If you’re living with chronic knee pain and looking for alternatives, or ways to delay knee replacement, this episode offers valuable insight into a promising option that’s changing how knee osteoarthritis is treated.

For more information about genicular artery embolization for knee pain, go to medstarhealth.org and search interventional radiology or for an appointment, call 240-434-7237. If you would like to comment on this podcast or recommend a topic for another episode of DocTalk, send an email to doctalk@medstar.net.

For more episodes of MedStar Health DocTalk, go to medstarhealth.org/doctalk.

Transcript

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Comprehensive, relevant, and insightful conversations about health and medicine happen here on MedStar Health Doc Talk. These are real conversations with physician experts from around the largest healthcare system in the Maryland, DC region. There are a lot of reasons why approximately 25% of adult Americans have chronic knee pain. Those joints bear a lot of weight and are prone to injury. Then there's osteoarthritis, arguably the most common joint disease in the world. And what is that? Well, it happens when the protective cartilage at the end of the bones gradually wears away and oh, the pain when the buffer between them is gone. Bone on bone pain can lead to a long list of treatment options. Today, we're going to talk about one that you may not have heard of, genicular artery embolization or GAE. It's new to me and I can't wait to hear more about it from today's guest. Welcome vascular and interventional radiologist, Dr. Moutasem Aljundi, board certified in interventional radiology and diagnostic Health. I'm your host, Debra Schindler. Thanks for being with me today, Dr. Aljundi. Thank you, Deborah, and thanks for hosting me. From the research I did, genicular artery embolization is still fairly new, and there isn't a lot of solid data yet about how many GAE procedures are performed in the US. Is it fair to say that GAE is still an emerging treatment? It is emerging. However, it's been established and became increasingly popular in the United States over, I would say, the past five to six years. It's been done outside the United States for longer than that. It's a procedure that became increasingly popular around 2016, 2017, and in the United States, I'd say after 2020, 21. As you said, chronic knee pain. The leading cause for that is knee osteoarthritis, which is a disease that has high prevalence in the US and in the world. And there is a lot of research that is happening all over the world on new procedures and interventions, as well as surgeries to help patients with knee pain. This is probably one of the newest interventions that we've had, and there is still more to know about it. There is still more research that is being done, particularly to look at the long-term efficacy as well as the safety of the procedure. We have very good data on the short-term and intermediate-term results, and this data shows very promising results in helping patients with chronic knee osteoarthritis. Well, it seems from my research anyway, that genicular artery embolization is usually only available at academic medical centers or large interventional radiology programs, such as MedStar Washington Hospital Center, which is one of our sister hospitals in DC. What drew your interest in it to bring it here to MedStar St. Mary's Hospital? Well, when I joined MedStar Health back in 2021, first, I work here in St. Mary's Hospital, but I also do procedures at MedStar Washington Hospital Center, as well as MedStar Southern Maryland Hospital. The goal was to, when I joined MedStar Health, is to build a comprehensive IR service here at MedStar St. Mary's Hospital to be able to provide the services that we provide in DC and our larger centers for our local community here at St. Mary's Hospital. Nice. And many of those procedures were not performed here before, but slowly we were able to build, I would say, a comprehensive clinical IR practice here. We started by establishing an interventional radiology clinic where we evaluate patients pre-procedurally, then we perform the procedure here and we do our own follow-ups here. And I think that has helped a lot of patients because previously patients would have to travel to get a lot of these procedures in one of our tertiary hospitals. Well, listen, I can tell you, I just got back from a trip to Greece, and most of the people in my tour were over 50, and at least half of us had our knees wrapped up, including myself and my husband for different issues. So knee pain is so common once you hit the age of 50, it just seems like everybody has a story to tell. Let's go through some of the standard treatment options for knee pain. The prevalence of knee pain is very high. It mostly happens in people above the age of 50 to 60. You see it equally in men and women with a slightly more seen in females. The leading cause of chronic knee pain is knee osteoarthritis. And knee osteoarthritis can be divided into primary osteoarthritis, which is mainly caused by wear and tear factors. And then secondary osteoarthritis that can be caused by secondary reasons such as injuries, trauma, knee infections, and other reasons. And there are other sources of arthritis or other arthritis that happen in the knee that are inflammatory in nature. Those include oriatic arthritis, rheumatoid arthritis, and other ratiologies. But by far, the most common cause of chronic knee pain, particularly in patients above the age of 50 to 60 is primary knee osteoarthritis. The wear and tear of the old knee. Yes. Where does this genicular artery ablation come into play? What does that mean, genicular? Genicular means knee. An array is the arris of the knee and embolization is the medical word for stopping or decreasing the blood supply to an organ. In simple words, it means that we are decreasing the blood flow to the knee. And we're getting into a little bit more into the details. Why do we need to do that? And how does it help patients with knee pain from osteoarthritis? But let's go back and talk a little bit more about the etiology of the osteoarthritis. For a long time, we used to think it's just simple wear and tear. The knee joint is a joint that connects the femur bone in the thigh and the tibia in the leg. And in between those two bones, there is cartilages and menisci, which act as buffers to prevent friction between the bones when you move your knee. With wear and tear, what ends up happening is those cartilages get damaged and the bones get closer to each other and they start touching each other when you're moving, and that leads to inflammation. And with time, that inflammation keeps getting worse and it leads to knee pain. What we've also discovered that the pathophysiology includes also a repetitive injury, and that happens because when the cartilages get damaged, they release chemicals into the joint space. Those include stuff like cytokines, interleukins, and other enzymes. Those enzymes end up causing more damage to the cartilage because they cause more degradation in the cartilage and they lead to more inflammation. And most patients end up getting into this vicious cycle where wear and tear causes damage to the cartilage, more chemicals are being released into the joint and more damage is happening. So the idea of genicular embolization came from the fact that this process is a chronic process where there is a vicious cycle of damage and inflammatory process that is happening, and that inflammatory process causes more damage. And that's what happens in the knee joint. In chronic inflammation, for the inflammation to continue happening, the body initiates an immune response. And part of that immune response is increasing the blood supply to the area to maintain that inflammatory process. The inflammation happens because the body is trying to react to that injury that is happening, that damage that is happening. So inflammation is an increase of blood flow? Part of the inflammatory process is, yes, increase of blood flow to the knee. And the inflammation is what causes the pain? Part of the pain, yes, is caused by the chronic inflammation that is happening in what we call the cynovium, which is the outer lining of the knee joint. There's other things that are happening, which is formation of osteophytes, which is excessive bony spares that happen in the knee joint, buildup of fluid, which we call joint effusion. Also, these things contribute to the stiffness, the pain, and all the other symptoms that patients with knee osteoarthritis experience. So when you think about inflammation, to simplify it, any inflammatory process involves an increase of blood supply. So when you get stuck by a mosquito, that area gets red and swollen because there is a localized inflammation that happens there. And it gets read because the body through that inflammatory process is increasing the blood flow to that area. Same phenomena is happening in the knee. So the idea was that we need to stop that inflammation or minimize that inflammation. And one of the ways to stop that inflammation is by blood supply to the knee while maintaining the major blood supply to the tendons and other parts of the knee. That's why Dr. Akuna in Japan started his research on Jenica R. Embolization. I think he started in 2012. And the first study that was published on a large scale of patients on gene care artery embolization was published by Dr. Akuno and his partners in 2017. That study involved, I think, 75 patients and 92 knees that were treated, and it showed promising results in improving pain, stiffness, and other symptoms of chronic osteoarthritis in patients up after the procedure for three years. So interestingly, this doctor in Japan was not an orthopedist or sports medicine doctor. He was an interventional radiologist. Most of us go for knee pain to an orthopedist or a but they need to see an interventional radiologist. Explain why. Because the treatment for knee oso arthritis, as you said, it starts with minimal interventions such as lifestyle modification that includes weight loss, cold packs, sometimes elevation of the lower extremities help with it. But when the osteoarthritis becomes moderate or severe, those interventions are not enough to help with the pain. And most patients start with medical treatment that includes non-steroidal and anti-inflammatory medications such as ibuprofen, as well as joint injections. Those include steroid injections, gel injections, some that are more other novel injections include plasma injections and stem cells that have been studied. And then in cases with moderate to severe osteoarthritis, also patients go to see an orthopedic surgeon to be evaluated for a knee, total knee arthroplasty or people call knee replacement surgery. The golden standard for the treatment of severe ostoarthritis is still knee replacement surgery. However, there is a lot of patients out there who cannot have knee replacement surgery for medical reasons or would like to hold off on knee replacement surgery for one reason or another. And that's where genicular embolization comes in. So it is an intervention that is appropriate for patients who have failed conservative measures-. Continue to have pain. ... and. Continue to have pain despite conservative treatment and are either not good candidates for knee replacement surgery or would like to hold off on knee replacement surgery. That's where it falls into the spectrum of treatment of knee osteoarthritis. I also read that some patients who opt for this GAE have had a knee replacement, but still have residual pain, and it seems to help with that. Yes. So about 15 to 20% of patients who have knee replacement surgery, they still complain about knee pain. And this is one of the interventions that is available for them to consider if they continue to have symptoms of knee pain after knee replacement surgery. I would say the patient population that would be good candidates for this are patients who have mild to moderate osteoarthritis. Those are being evaluated, of course, by their orthopedic surgeon, but they can also be evaluated by an interventional radiologist. There is a both subjective and objective evaluation that can be done. And based on that evaluation, we can determine their candidacy for the treatment. The most common surveys that we use to evaluate the severity of the symptoms of osteoarthritis are something called WOMAC score. There's also a COS score, a VAS score. Those are scores that are basically built on a survey that the patient fills that include pretty much all the symptoms of osteoarthritis. And this enables us to get an objective idea on how severe the osteoarthritis in the patient's symptoms, and also helps us evaluate the response to the treatment after we do the intervention. The WOMAC score, for example, is a survey that includes 96 questions that the patient answers before the procedure when they are being evaluated for the procedure and we have them fill it in their follow-up visit after the procedure to evaluate the response for treatment. For us, after genicular embolization, the threshold for success is 50% improvement in their WOMAC score or their pain level. A lot of patients have much more improvement, but the threshold for success, it's 50% or more improvement in EP. So how long have you been doing the procedure here? St. Mary's about a year now, and we've been doing it in the system for, I think, two years. Is it too soon to ask your rate of successes? I would say ... Let me answer this question by saying that the experience in the United States has been so far, and my experience has been similar to other physicians' experiences. About 70% successful. 70% Of patients are very happy with the result? Yes. And we're still trying to figure out those patients, though 30% of patients who did not have improvement, what are the reasons for that? Because a lot of patients that we evaluate for the procedure and they seem like good candidates for the procedure and we think that they would have improvement among those 30% end up not having improvement, but that does not correlate with the severity of symptoms or the findings on their imaging. A lot of times we obtain an MRI of the knee to evaluate for sinovirus, which is the inflammation of the outlining of the knee joint. And we do think that the areas of inflammation should pain for the patients and would correlate to what we call angiogenesis, which is the increase of blood flow to the outlining of the knee. But there is still more to be studied on the procedure to evaluate, of course, the long-term results of it. Well, the first study just came out in 2017, so I think it's fair to say that we are still early in evaluating or looking at the success of. Genicular. After that study, there have been many studies that came out, many in the United States that came out. And most of the studies that were done have shown that the procedure has good efficacy, at least on the short and intermediate term. I would say most of the studies have followed up patients now up into a year, and some studies have followed up patients to two years with very good success rates. The 2017 study have shown 90% improvement and the WOMAC scores at one year, and those patients were followed up for three years, and about 80% have had no intervention at three years, no additional interventions needed three years. Of course, some of the patients were not followed up for three years for one reason or another. Some of the studies that were done in the United States, now they're trying to keep following up patients to try to identify the long-term efficacy as well as the safety profile of the procedure. So the 70% that you mentioned before who had a successful procedure or came away feeling that they have shown improvement, who are they? What qualifies them as an ideal candidate? What do you think led to their success? So for us, a good candidate for a gene care embolization procedure is a patient who has been diagnosed with chronic knee osteoarthritis that has failed conservative measures and is either not a candidate for total knee arthroplasty or would like to hold off or total knee arthroplasty for one reason or another. Most patients with mild to moderate osteoarthritis would be great candidates. But 30% of them aren't having the great improvement that 70% are having. What do you think the distinguishing factor is? That could be related to other reasons of knee pain. So chronic inflammation is one of the etiologies of knee pain in osteoarthritis, but as I said, there are other changes that happen in the knee with chronic osteoarthritis, and that could be contributing to it. Well, walk me through the procedure. I'm a patient, I'm coming in, I'm having this done today. What is going to happen? So interventional radiology is a specialty where we perform minimally invasive procedures that are image guided. So pretty much all of our procedures involve small incisions that are a size of pinhole. In generic embolization, the patient comes into an interventional radiologist suite. In most cases, the genetic embolization is an outpatient procedure that is being done under moderate sedations. Some people call it twilight. So after the patient is being evaluated in clinic, they come as an outpatient, they get an IV, and they come into an interventional radiologist suite where they receive IV sedation. They're laying flat on their back? They're laying flat on their back on the interventional radiology suite table where there is an x-ray machine that is going to be moving around them that would help us visualize the RAs that we want to treat. We create a pin size hole in the groin of the patient, and then we insert a hollow tube that is the size of a spaghetti noodle into the RA that goes down the thigh into the knee. After that, we use contrast dye to evaluate the RAs around the knee. And what we're trying to find here is which REs are supplying the areas of pain. In pre-procedural evaluation, we place imaging markers that can be seen on x-ray that would show us the areas of maximum pain that patients have. Once we've identified those arrays, there are six or seven RAs that most of the time we interrogate. We use a smaller catheter to navigate into those smaller arrays. And after that, we inject small particles that would go into the distal capillaries, the very tiny REs that are feeding the cynovium. And the goal is to minimize the blood flow in that area without stopping the blood flow to the knee. So we want to take that excessive blood flow that is keeping the inflammatory process happening while maintaining the blood flow into the main artery that is feeding the area of the knee so that patients don't get complications. After we're done with that, sometimes we do a CT scan while the patient is on the table to identify the arterial blood supply to the cynovium, as well as to other structures around the knee, and make sure that we are not sending those particles to any other structures that we do not want to stop blood blood flow to. What's particularly important here is the blood flow to the skin around the knee because we want to minimize any of those particles go into the skin that would cause-. Because I understand that reducing the blood flow to the inflamed tissues helps decrease inflammation and pain, but it seems risky to interfere with the blood flow to the knee, like you said, to the skin or to other parts of the knee that need that blood flow. So how do you make sure that you're not embolizing? And we didn't talk about what's happening with the embolization. How does that happen? How are you embolizing those little arteries, those tiny little-. The idea of stopping blood flow to organs is actually not new. There are other well-established procedures that we've period of time where we go and stop blood flow either completely or partially to certain organs to help with a certain medical problem. Such as what? Examples for that is prostate artery embolization, for example. It's a well-established procedure that we perform to stop the blood flow to the prostate in patients who have benign enlargement of the prostate or what is called benign prosthetic hyperplasia. And by doing that, we help the prostate shrink and that would alleviate the symptoms of prostate enlargement, such as urinary obstruction, urinary infections, and other symptoms or prostate enlargement. And you're watching it with the contrast and the imaging. You're able to see that. On a screen. When you're doing an embolization, you are doing it live. So you are watching your contrast going into the knee. And one of the things that we have to mention here is that we're talking about small arteries and the embolic particles that we're using, we're talking about very small amounts. The total amount of embolic that is being used in a typical genicular embolization case, not more than two to three ccs. Tell me how the embolization happens. So once you have inserted what we call a microcatheter or a small catheter into the genicular RA, you do what we call an angiogram, which is an x-ray image with contrast being given to evaluate the blood supply to the cynovium, as well as if that RA has any additional blood supply to any other organs. We try to go as selective as possible. If there is other branches that are going to the knee, we try to other structures such as the skin, we bypass those branches. We go deeper in the RA until we get into a location where it is safe to deliver the embolic material, the embolic bartles. Then we inject those embolic barticles in the artery. The average amount that I would use in a single genicular artery is about 0.3 to 0.5 ccs of embolic. After that, we recheck the RA to make sure that we have decreased that extra blush, extra blood flow to the knee while we're maintaining normal blood flow. Today. And how does that appear to you when you know that it's been successful? Are you just not seeing the vein again show up on this image because it's. Gone? You see blood flow into the major artery that is going to the knee, but you don't see it excessively filling ... We call it blush, and it's very difficult to explain without actually looking at images. I see. If I had images, I would've shown you the before and after embolization, but you see kind of a staining of contrast and blood on the cynovium before, and that staining goes away after the embolization. That tells us that we minimize, we block those small capillaries and the distal part of the artery that we're contributing to the inflammation. So you know right away that you have just neutralized these arteries that are going to feed to the pain or this inflammation? Yes. The small-. You can tell that right away. Yes. The small capillaries. So after injecting the embolic, you normally do a follow-up angiogram to evaluate the completion of treatment. And if you see that you have decreased that blood flow to that part of the knee, then you know that your treatment has completed. Yes. What kind of knee conditions would benefit ... We talked about osteoarthritis and what about a meniscus tear like I have, like I'm suffering with right now. So if the meniscus tear has led to osteoarthritis and chronic inflammation in the knee, that might be an option. Patients who have knee injuries, we have to always keep in mind that there are surgical procedures that can be done that treat the actual pathology in the knee. For example, in menuscar tears, there is surgeries that can be done by orthopedic surgeons. We can fix that meniscal tear and it might be a better option for patients. In general, I think genetic embolization, most of the data that we have now are for patients who have primary osteoarthritis, meaning that patients have just wear and tear that led to thinning of the cartilage and chronic inflammation in the knee. Would GAE be an alternative to a knee replacement? Alternative, no. I think it would be a junk treatment. It would add to the spectrum of resiments that are available. Maybe you can postpone a knee replacement having. That- That would be one of the reasons you use genical RA embolization. It would be used for patients who cannot get knee replacement surgery or patients who've had knee replacement surgery and they still have symptoms of knee pain after knee replacement surgery. Knee replacement surgery been around for a long time and it's a very, very successful procedure and it has a very good safety profile and it's been studied. Tried and true. And it's been studied a lot. We have to understand that the prevalence of the disease is very high. And a lot of patients, they cannot, for one reason or another, cannot undergo knee replacement surgery or they would like to postpone the procedure. So genetic art embolization comes into along that spectrum to help those patients. How is it different from nerve ablation? And in generic nerve ablation, what we do is we don't treat the etiology of the osteoarthritis. We try to treat the symptoms of it. So there are around four nerves that it sensation from the knee, and those nerves are the sensory nerves that make you feel the pain from what is happening in the knee. So what we do is it's a two-step procedure. So the first step is a test where we insert needles into the locations of those four nerves, again in an IR suite under imaging. The patient is in a twilight. Patient again is twilight. It's very similar. It's an outpatient procedure. Patient comes in, they get an IV, they get twilight medication, and then they are flat on the interventional radiology table. We use x-ray to identify the anatomy of the knee, and then we insert small needles into the location of those nerves. Then we inject pubificate, which is a local anasteric that blocks the function of those nerves. This is the test part of treatment. That helps us identify who are the patients that are candidates for genical nerve ablation and who are not. We normally follow up with patients in a few days after the test block. This is called geneker nerve block. We follow up with patients a few days after that. And if the patients report 50% or more improvement of pain, again, the threshold for us here is 50% improvement in their They would be candidate for genic nerve ablation. In geneic nerve ablation, we use cooled radiofrequency technology in which we insert four needles into the locations of those four nerves around the knee under twilight sedation, and we burn those nerves there. The test is a temporary and it helps us identify the-. And you want to see if it's going to work. Exactly. Patients who would be a candidate for ablation. The test normally is done once at the initial intervention, and if the patients are going to have repetitive ablations, they don't have to get tested every time. They get an ablation. The problem with a lot of the interventions that were embolization for knee pain, lifestyle modification and medications, oral medications, and before total knee replacements, they're temporary. So most of them, they give you relief from knee pain for about three to six months when they're successful. And that includes steroid injections, nerve ablation, and all the others. So one of the things that I tell patients, if you're a candidate for drinking nerve ablation, expect that this would give you relief if the procedure is successful, to give you relief for about six months, if it is successful. And most patients would require two ablations a year. Some patients, the effect of it is a little bit longer, can go up to nine months. And I've had patients for a year, but I would say for most patients, effect of it is between three to six months, and they have to have repetitive ablations. Genegra embolization, on the other hand, at least what the data has shown us that when it is successful, patients have relief for one year and it could be longer than that. So sometimes patients choose to go for generic embolization just for the sole reason that I want to have one procedure that gives me as long as possible of a relief as compared to a procedure where I have to come back in three to six months to have another procedure. Is the relief after the procedure immediate? Most of the patients would experience relief within the first few weeks after the procedure. It's kind of a progressive relief because it would take time for the inflammation to decrease. Most of the studies that have been done have looked at patients at one month, three or four months after the treatment, six months, 12 months, and 24 months. When it works, most patients have reported relief or improvement in their knee pain at one month after the procedure. Patients at one to three months after the treatment. And for patients who report improvement in their symptoms, most of them, they report for significant improvement at one month after the procedure. Do they ever get a second procedure that ultimately produces an even greater result? Of. For generic embolization, we're still trying to figure out the long-term efficacy of it. For genicular nerve ablation is a different story. Yes. They will most likely at six months- They can get multiple. They will get another procedure. And I think one of the advantages of nerve ablation and R embolization is that you're not using steroids. The problem with steroids is steroids are great. It's a great intervention to start with. The problem with them is that your body develops tolerance to the steroid with multiple injections. And most patients come to you and say, "Okay, well, I had a steroid injection that worked first, but then after the second or third injection, it's not giving me the same results or it works for much shorter period of time.". A patient comes to you with knee pain. How do you decide between genetic artery embolization or genecular nerve ablation? How do you decide which procedure to do? Many patients are actually candidates for both procedures. We try to select patients based on their symptoms, how severe is their osteoarthritis is, and if they've had interventions before. Some patients, genetic artery embolization is contraindicated to. If you have peripheral artery disease, for example, where you have calcium in the REs that are feeding the leg down, those are not good candidates for generic embolization. If you have a localized infection or a recent infection around the knee, you don't want to perform a geneic artery embolization. Patients with renal impairment, for example, because we're using contrast dye, although it's a very small amount of contrast dye, but if you have another alternative where you don't have to use a contrast dye, those patients, I offer them genetic nerve ablation first. For me, those procedures are interchangeable. I offer both procedures to the patients and a lot of times, and patients sometimes choose one over the other. And I tell them that if it doesn't work, we can always cross to the other procedure and do the other procedure because those are targeting different parts of the knee or they're treating the knee pain in two different ways. Now, since you're going in through the femoral artery for this catheter procedure, essentially, does the patient have to lay still for six hours or whatever after the procedure to make sure that there's no bleeding? The incision that we make and the hole in the artery that we make is very small hole that most patients are within two hours after the procedure. They can get up and move around. We hold pressure after the catheter is out. And most patients, they can get up out of bed and move around after two to three hours after the procedure and they can go home on the same day. The most important thing that also makes a big difference in patient's quality of life is that they are able to return to their daily activities the day after the procedure. So that's also important to a lot of patients. Some patients would like to postpone knee replacement because they don't have the time for recovery for knee replacement. They're taking a trip or their daughter's getting married and they want to dance at the wedding. Believe it or not, most of my patients come in with certain timelines that they want their knee pain. They need their pain better. They need their pain better before they need that. Timeline. I needed it for my trip to Greece for sure. What should patients ask their doctors if they would like to entertain this procedure for knee pain? I think patients with knee pain should be educated about the options that they have. What I'm trying to do here and what we try to do in other venues is we try to educate not only patients, but also physicians or practitioners in the community about all these options because they might not know about them. Do orthopedists send you patients? Yes. Most of my patients actually come from our partners in orthopedic surgery. We have a very good and strong working relationship with orthopedic surgeons here in St. Mary's Hospital. Through that relationship with interventional surgery, you can create a treatment plan for patients. For example, sometimes orthopedic surgery sends me patients who need pain relief until they get their knee replacement surgery in six months or nine months. And they have an occasion or a trip that they have to go to in those nine months. They would like to have that pain relief during that period. So a lot of times I perform a knee ablation to give them that relief and bridge them to get their knee replacement surgery. I guess it's like anyone going in for a cortisone shot or their gel shots. It's a temporary relief, but effective. It is, but it's not the temporary relief that you get from the steroid injection or the nerve ablation. What we've seen that it gives you much longer relief as compared to some of the other interventions that we. Have. Can artery embolization be used on other types of joint pain, maybe hip pain, for example? There are early studies out there that are been evaluating the effectiveness of similar procedures on different joint pains. Nothing has been established yet, but the thought is that if this works very well for the knee, why not use it for other joints? Sure. I know there is a lot of studies that are out there that are looking at shoulder pain or shoulder osteoarthritis, elbow osteoarthritis, and plantar fasciitis is actually one of the most studied areas for embolization. Again, a lot of these diseases are very common, but have a high prevalence in the community. And if disease like plantar fasciitis, sometimes the interventions that are available are not very helpful with. So it would be great to have. An additional- Or they're very painful. Yeah, they're very painful. And it would be great to have another intervention that could help those patients. Is there anything that patients can do to improve either before or after the procedure to improve the outcome of it? I always say that any intervention that we do for back pain, for knee pain, for hip pain, physical therapy is always very helpful. And I pretty much refer all my patients to physical therapy after I do the intervention because it will help patients in restoring the range of motion around that joint and restoring muscle strength. Sometimes when you are in pain, you're not using the joint as much because of pain and you end up losing muscle mass around that joint. Well. This is all very new and exciting, Dr. Aljundi. What is it that you think patients need to take away from this podcast about genecular artery embolization? I think the message is there is a promising intervention that is available for patients with knee osteoarthritis that has shown good results, good safety profile, that might be an option for them. Not everybody is a good candidate for the procedure, but specifically for those patients who are not candidates for total knee arthroplasty and they are dealing with osteoarthritis pain on daily basis and the steroid injections don't work for them, they basically run out of options for neosteoarthritis. That's an option for them. And I think that is where this procedure becomes life changing for some patients. There's so much work that you guys do in interventional radiology that I am learning about. Every time I do a podcast, it's something new and exciting in that specialty. Do you love it? That's where I actually went. One of the main reasons I went into interventional radiology, it's a medical specialty where you perform cutting edge procedures with advanced imaging. There is always innovation. There are always new procedures that come out. And the fact that we treat medical conditions pretty much all over the body. So we treat liver cancers, kidney cancers, back pain, knee pain, fibroids, prostates. My day could include patients who have prostate problems, then Uterine problems, then back pain problems, then cancer treatments. So it always keeps me excited. It always keeps me motivated to come to work and try to help patients. I think many of the procedures that we do have great results in changing the quality of life for our patients. Well, I love your passion and your energy. Thank you, Dr. Aljundi. My pleasure. Thank you for sharing your expertise with us here on MedStar Health Doc Talk. For more information about genicular artery embolization for knee pain, go to medstarhealth.org and search interventional radiology or for an appointment, call 240-434-7237. If you would like to comment on this podcast or recommend a topic for another episode of DocTalk, send an email to doctalk@medstar.net.