Genicular Artery Embolization for Refractory Pain After Total Knee Arthroplasty: Clinical Outcomes From a Pilot Study

Genicular Artery Embolization for Refractory Pain After Total Knee Arthroplasty: Clinical Outcomes From a Pilot Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Genicular Artery Embolization for Refractory Pain After Total Knee Arthroplasty: Clinical Outcomes From a Pilot Study Hüseyin Saygin Tuna, Benjamin Reichardt, Koroush Kabir, Umit Mert, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9108145/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Purpose : To evaluate the clinical outcomes and safety of selective transarterial genicular artery embolization (GAE) in patients with refractory pain following knee arthroplasty without evidence of prosthetic loosening, infection, or mechanical failure. Materials and Methods: This single-center retrospective cohort study included consecutive patients who underwent GAE for refractory post-arthroplasty knee pain between January 2022 and December 2025. Pain and functional outcomes were assessed using the Numeric Rating Scale (NRS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS) and Total Analgesic Consumption Score (TACS) at baseline and at 1, 3, 6, and 12 months. Changes from baseline were analyzed using the paired Wilcoxon signed-rank test. Complications were classified according to Society of Interventional Radiology standards. Results : Fifteen patients (median age, 67 years) underwent GAE. Median baseline NRS was 7.0 (IQR, 6.0–8.0). Significant pain reduction was observed at 1 month (median NRS, 1.0; p < 0.001) and pain reduction was most pronounced during the first 6 months, with partial attenuation at 12 months. WOMAC and KOOS scores demonstrated parallel significant improvements through 12 months (p ≤ 0.041). TACS scores improved significantly through 6 months (p ≤ 0.026). Repeat embolization was performed in 3 patients (20%). No major complications occurred; minor transient adverse events were observed in 2 patients (13%). Conclusion : Genicular artery embolization was associated with significant improvements in pain and function with a favorable safety profile in patients with refractory post-arthroplasty knee pain. Genicular artery embolization Total knee arthroplasty Refractory postoperative pain Transarterial embolization Synovitis Interventional radiology Figures Figure 1 Figure 2 Figure 3 Full Text Additional Declarations Tables 1 to 4 are available in the Supplementary Files section. Supplementary Files Table1.docx Table2.docx Table3.docx Table4.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 20 Mar, 2026 Reviewers invited by journal 20 Mar, 2026 Editor assigned by journal 20 Mar, 2026 First submitted to journal 17 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9108145","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":609354249,"identity":"b939b6f6-28b3-41d3-9254-e490be6fec4f","order_by":0,"name":"Hüseyin Saygin Tuna","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8klEQVRIiWNgGAWjYLCCBAjF+BhMMTM3EKVFAqTWmIHBAEgxEqGFAaKFTRqshYGAFvn2M8YvHu5gqDO43fysuqDiTzR/O1DLj4ptOLUYnMkxs0g8wyBhcOeY2e0ZZwxyZxxmbGDsOXMbtxaGHDODxDaglhsJZrd52wxyG4BamBnbcGuR738D05L+rRikZT4hLQw3cowfQLTkmDGDtGwgpMXgxrMyBqAWyZk3coqlec4Y524EajmIzy/y/cmbP/5sY+Dnu5G+8TNPhVzuvPOHDz74UYHHYQwcZsA4+Y8qdgCPeiBgf/wBv4JRMApGwSgY8QAAhu5YYWIw5nYAAAAASUVORK5CYII=","orcid":"https://orcid.org/0009-0004-1373-6305","institution":"HELIOS University Hospital Wuppertal: HELIOS Universitatsklinikum Wuppertal","correspondingAuthor":true,"prefix":"","firstName":"Hüseyin","middleName":"Saygin","lastName":"Tuna","suffix":""},{"id":609354250,"identity":"53b3bf6a-99ec-4635-9592-8c08fb1c75b4","order_by":1,"name":"Benjamin Reichardt","email":"","orcid":"","institution":"Hochsauerland Hospital GmbH: Klinikum Hochsauerland GmbH","correspondingAuthor":false,"prefix":"","firstName":"Benjamin","middleName":"","lastName":"Reichardt","suffix":""},{"id":609354251,"identity":"e8a46c7f-b8bb-4dca-a9ed-2a9422a1b2d0","order_by":2,"name":"Koroush Kabir","email":"","orcid":"","institution":"HELIOS University Hospital Wuppertal: HELIOS Universitatsklinikum Wuppertal","correspondingAuthor":false,"prefix":"","firstName":"Koroush","middleName":"","lastName":"Kabir","suffix":""},{"id":609354252,"identity":"90f24bdc-8f7e-4749-90eb-fc0f8ba4962a","order_by":3,"name":"Umit Mert","email":"","orcid":"","institution":"HELIOS University Hospital Wuppertal: HELIOS Universitatsklinikum Wuppertal","correspondingAuthor":false,"prefix":"","firstName":"Umit","middleName":"","lastName":"Mert","suffix":""},{"id":609354253,"identity":"f0803b0f-4189-4341-9bec-d563c9af910c","order_by":4,"name":"Fahrettin Kucukay","email":"","orcid":"","institution":"Eskisehir Osmangazi University Faculty of Medicine: Eskisehir Osmangazi Universitesi Tip Fakultesi","correspondingAuthor":false,"prefix":"","firstName":"Fahrettin","middleName":"","lastName":"Kucukay","suffix":""},{"id":609354254,"identity":"1f7b3f75-cb61-4449-98d4-76d382d4c1f1","order_by":5,"name":"Patrick Haage","email":"","orcid":"","institution":"HELIOS University Hospital Wuppertal: HELIOS Universitatsklinikum Wuppertal","correspondingAuthor":false,"prefix":"","firstName":"Patrick","middleName":"","lastName":"Haage","suffix":""}],"badges":[],"createdAt":"2026-03-12 20:34:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9108145/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9108145/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105409859,"identity":"8bfd1757-deb3-4b48-b230-4eeb9938250e","added_by":"auto","created_at":"2026-03-25 17:11:00","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1522014,"visible":true,"origin":"","legend":"\u003cp\u003eAngiographic findings in a 66-year-old patient with pain and related symptoms after short-stem total knee replacement (TKR). (a-b) DSA from the superior medial genicular artery of the left popliteal artery before (a) and after (b) embolization. Abnormal vascular vessels confirmed by selective angiography of the superior medial genicular artery of the left popliteal artery (a). Significant reduction of abnormal vessels confirmed by angiography after embolization with imipenem–cilastatin (IPM/CLS) suspension (b).\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9108145/v1/e4c168a0904825e58cf63f87.png"},{"id":105409882,"identity":"591bd26b-5e40-44d0-b4b5-d1399ddfe8fc","added_by":"auto","created_at":"2026-03-25 17:11:06","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":144758,"visible":true,"origin":"","legend":"\u003cp\u003eTime course of pain and functional outcome scores following genicular artery embolization. Median Numeric Rating Scale (NRS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), and TACS scores at baseline and follow-up intervals (1, 3, 6, 12, 18, and 24 months). A marked reduction in pain (NRS) and improvement in functional scores (WOMAC and KOOS) were observed within the first month after embolization, with midterm benefit through 12 months. TACS scores demonstrated early improvement with relative stability during follow-up.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-9108145/v1/85ddd68772e5ff9623f74105.png"},{"id":105409861,"identity":"f2d5330b-eaea-4f67-be9e-b86300114d5a","added_by":"auto","created_at":"2026-03-25 17:11:01","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":146636,"visible":true,"origin":"","legend":"\u003cp\u003eTime course of median Numeric Rating Scale (NRS) scores following selective genicular artery embolization in patients with refractory post-arthroplasty knee pain. A pronounced early reduction in pain is observed at 1 month, followed by gradual partial attenuation over time. Median NRS values remained below baseline at all evaluated follow-up time points through 12 months. Responder analysis at 12 months demonstrated that 5 of 15 patients (33%) maintained a ≥2-point reduction in NRS, and 4 of 15 patients (27%) achieved a ≥30% reduction from baseline, indicating sustained clinically meaningful improvement in a subset of patients.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-9108145/v1/8a79123cf74c78ff5a47e391.png"},{"id":105409925,"identity":"c6f50e3a-da3f-4d12-83da-e414f3329371","added_by":"auto","created_at":"2026-03-25 17:11:26","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":827396,"visible":true,"origin":"","legend":"","description":"","filename":"lastmanuscriptcorrected.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9108145/v1_covered_4203da2d-522d-4177-9f39-6a00e99a40a2.pdf"},{"id":105409822,"identity":"49ce13d8-b599-486b-b6bb-9b04cc6198b9","added_by":"auto","created_at":"2026-03-25 17:10:58","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":15101,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-9108145/v1/748f4396249d59f92b774ff1.docx"},{"id":105409868,"identity":"05e1bb82-45f8-4d12-a728-b3491a8107ad","added_by":"auto","created_at":"2026-03-25 17:11:02","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":27920,"visible":true,"origin":"","legend":"","description":"","filename":"Table2.docx","url":"https://assets-eu.researchsquare.com/files/rs-9108145/v1/2dae1a3bd6e3c37d8173b7a3.docx"},{"id":105409880,"identity":"def99230-45b1-44b7-aaef-5e6153ba3fe5","added_by":"auto","created_at":"2026-03-25 17:11:05","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":26835,"visible":true,"origin":"","legend":"","description":"","filename":"Table3.docx","url":"https://assets-eu.researchsquare.com/files/rs-9108145/v1/3204455f5d267e404d596063.docx"},{"id":105409884,"identity":"e6ea28f8-e0e5-4712-a634-2962215f4e61","added_by":"auto","created_at":"2026-03-25 17:11:06","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":14752,"visible":true,"origin":"","legend":"","description":"","filename":"Table4.docx","url":"https://assets-eu.researchsquare.com/files/rs-9108145/v1/7da17f247ebeadc585850601.docx"}],"financialInterests":"\u003cp\u003eTables 1 to 4 are available in the Supplementary Files section.\u003c/p\u003e","formattedTitle":"Genicular Artery Embolization for Refractory Pain After Total Knee Arthroplasty: Clinical Outcomes From a Pilot Study","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"cvir-endovascular","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cire","sideBox":"Learn more about [CVIR Endovascular](https://www.springer.com/journal/42155)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/cire/default.aspx","title":"CVIR Endovascular","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Genicular artery embolization, Total knee arthroplasty, Refractory postoperative pain, Transarterial embolization, Synovitis, Interventional radiology","lastPublishedDoi":"10.21203/rs.3.rs-9108145/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9108145/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e:\u003cbr\u003e\n To evaluate the clinical outcomes and safety of selective transarterial genicular artery embolization (GAE) in patients with refractory pain following knee arthroplasty without evidence of prosthetic loosening, infection, or mechanical failure.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Methods:\u003c/strong\u003e\u003cbr\u003e\n This single-center retrospective cohort study included consecutive patients who underwent GAE for refractory post-arthroplasty knee pain between January 2022 and December 2025. Pain and functional outcomes were assessed using the Numeric Rating Scale (NRS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS) and Total Analgesic Consumption Score (TACS) at baseline and at 1, 3, 6, and 12 months. Changes from baseline were analyzed using the paired Wilcoxon signed-rank test. Complications were classified according to Society of Interventional Radiology standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e:\u003cbr\u003e\n Fifteen patients (median age, 67 years) underwent GAE. Median baseline NRS was 7.0 (IQR, 6.0–8.0). Significant pain reduction was observed at 1 month (median NRS, 1.0; p \u0026lt; 0.001) and pain reduction was most pronounced during the first 6 months, with partial attenuation at 12 months. WOMAC and KOOS scores demonstrated parallel significant improvements through 12 months (p ≤ 0.041). TACS scores improved significantly through 6 months (p ≤ 0.026). Repeat embolization was performed in 3 patients (20%). No major complications occurred; minor transient adverse events were observed in 2 patients (13%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e:\u003cbr\u003e\n Genicular artery embolization was associated with significant improvements in pain and function with a favorable safety profile in patients with refractory post-arthroplasty knee pain.\u003c/p\u003e","manuscriptTitle":"Genicular Artery Embolization for Refractory Pain After Total Knee Arthroplasty: Clinical Outcomes From a Pilot Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-25 17:09:27","doi":"10.21203/rs.3.rs-9108145/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2026-03-20T12:56:51+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-20T09:13:39+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-20T06:56:50+00:00","index":"","fulltext":""},{"type":"submitted","content":"CVIR Endovascular","date":"2026-03-18T03:32:46+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"cvir-endovascular","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cire","sideBox":"Learn more about [CVIR Endovascular](https://www.springer.com/journal/42155)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/cire/default.aspx","title":"CVIR Endovascular","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"94fbf747-f2e1-469e-9f3c-f14d66e50f3c","owner":[],"postedDate":"March 25th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-06T13:49:45+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-25 17:09:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9108145","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9108145","identity":"rs-9108145","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}