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Scott Webb (Host): I'm Scott Webb, And I'm joined again today by Carle interventional radiologist, Dr. Scott Santeler. And today, he's here to tell us about how he's helping patients who are suffering from osteoarthritic knee pain using a procedure called genicular artery embolization.

Doctor, it's great to have you back on the podcast. Last time we talked about thyroid nodule treatment, radiofrequency ablation. And today, we're going to talk about chronic osteoarthritic knee pain. And I mentioned last time, I'm one of those people, like this is going to help me, going to help patients. So many people suffer from knee pain because of osteoarthritis. So, let's just start there foundationally for listeners who suffers from knee pain? What is osteoarthritic knee pain? And then, we'll get into some of the treatment options.

Dr. Scott Santeler: The people who will suffer from knee pain are people who have knees, in general. As we get older, it's probably something that all of us can look forward to. And the biggest issue with it is that, over time, you know, there's the extreme end where people actually need joint replacements.

But there's a lot of gap between people who are suffering with this, and it's limiting their lifestyle and limiting the things they want to do, and they're not ready, nor should they be ready to be getting a full joint replacement. And, you know, traditionally, people could take anti-inflammatory medicines to try to get through that.

Sometimes people experience joint injections, which my own family members go through, which are somewhat helpful sometimes, and often have to be repeated in whether or not they get a good injection at one time, which can include like viscous agents, or anti-inflammatory injections like steroid injections. But there's a huge gulf of people then who are still suffering with this.

And the really cool thing about genicular artery embolization is it seems like it's getting really good pain control, improved symptom relief, with effects that have been measured out to a year.

Host: Yeah. As you say, there's just a lot of folks suffering, and certainly a joint replacement is on the table, but maybe that's at the end after, you know, trying a lot of other things like GAE. So then, let's talk about that. Let's maybe identify, describe the role that GAE has in treating folks like myself who have this chronic osteoarthritic knee pain and how it's helping folks

Dr. Scott Santeler: Sure. I mean, the mainstays of a lot of joint troubles still remain. We will all probably be taking, you know, NSAIDs, ibuprofen or something. But that can be problematic, and it can cause other symptoms. You know, people can have gastrointestinal issues from taking that all the time. You know, physical therapy is still great, and we want to help to maintain people to be active.

But where GAE comes in is that it can address the effects of long-term inflammation in a more durable way. I don't want to pretend that it's going to totally fix things and it goes away. But this is about pain reduction, and it's also about symptom improvement, and that's really where it shines, and the durability of it.

You know, I want to take a moment to just, like—we often throw around these medical terms like osteoarthritis, and I like to conceive of or think of, you know, osteoarthritis is the generic arthritis or just inflammation of a bone. So, osteoarthritis, arth- is the joint, and -itis is inflammation. And the way I like to think about it, it's essentially this is a wear and tear problem. So, we tend to see this as we get older. We tend to see this with increasing age. But we all want to remain active.

And so, what genicular artery embolization is referring to is the genicular arteries are the arteries that go and supply the knee. And one of the things that can happen with inflammation is there's this sort of positive feedback loop where you get some inflammation, and the body is trying to fix and heal itself. But in the course of doing that, it creates this inflamed state. And that inflamed state sort of keeps things sore, keeps things painful. And when we're taking anti-inflammatory drugs, we are temporarily tamping down that state. But what genicular artery embolization is trying to do is actually try to treat this sort of positive feedback loop that is encouraging and keeping the inflammation present. And we do this by actually working inside the arteries directly.

Host: Yeah. You have a great way of explaining this without any diagrams or visual aids. And I guess, I'm just wondering, you know, in terms of, like we talked last time, what can folks expect, right? So, they're going to come in for GAE. Where do they go? How long does it last? Is there some recovery time, some limitations? No pickleball for a week? Like, how does that work?

Dr. Scott Santeler: I always like to see people ahead of time, you know, and I have a full clinic that I like to consult people with, see what's going on. I really want to understand where their pain is. The knee is a big thing. It could be on the inside or the outside. It could be on the front. And that very much helps me to know where to target the treatment.

You know, so what's involved with this is I do a lot of things inside blood vessels. Embolization is a technique where we inject deliberately inside blood vessels with the effort and intention to reduce or change the blood flow.

So, I do this in circumstances when people are bleeding from trauma or there's certain cancer treatments that I do this for. So, this is a technique that I've done for over two decades. It's very common in my specialty, vascular and interventional radiology. What's cool about it, though, is we're finding ways to apply this, in this case, to inflammation of the joints, and it's just been really well-studied, and it's showing really phenomenal results for knees.

And so, I get into the blood vessels. I usually like to go on the same side leg up by the groin. It's easy to access there. It's a very safe place to go. We scrub and clean the skin, as we would for any invasive procedure. I use a numbing medicine called lidocaine, which stings and burns, and I always tell folks to expect that. You know, I give a little light sedation. But again, I want to be able to talk to people. I want to make sure they're doing okay. I insert a needle into the blood vessel. And then, that lets me exchange the needle for a tube. And then, I can park the tube down by the knee, and I inject and find the individual blood vessels that are supplying the knee and are demonstrating the inflammation. And it's really quite clear on pictures. You can see the inflammation and what's called neovascularity, as all these inflamed vessels, become very enlarged, and they have a very distinct look to them. But this is also why I want to talk to people first. I want to know where they're having the most pain. So, I can focus and direct where I'm going to do the treatment.

And I use a little tiny thread-like catheter, and I position it in the blood vessels. And then, I administer an agent to sort of plug up these vessels that are overactive. I want to leave the normal ones behind. But I basically plug up the most active and irritated vessels. And by reducing that, that cycle, reducing the blood flow that's encouraging this cycle, that can get pain relief from people.

Host: And then, are there any limitations? How long are folks out of action after this procedure?

Dr. Scott Santeler: Well, it is an outpatient procedure. I want you to go home the same day. I would like usually that first day to take it easy. But after usually a couple hours, we can get you up and walking. And then, I'd like you to return to regular activities by the next day, actually

Host: Yeah, it's so cool and so glad we have experts, because you're explaining this like the way I would explain how to make a peanut butter and jelly sandwich. You know, it's really amazing. Let's finish up today, Doctor, and just talk about maybe some of the different treatment agents or targets that are being actively researched. It sounds like GAE, at least for you, is kind of the gold standard for folks that are at that stage of dealing with knee pain. But what else is out there?

Dr. Scott Santeler: Well, there's been a number of different techniques that people have tried to employ. This is so common, and this is a thing that so many people suffer around the world. And at this spectrum of, like, knee replacement, before we get to that level, people are looking for some relief.

I mean, there have been other people who have done what are called ablations of nerves, where you're actually trying to destroy the nerves around the joint. People get pain relief from that. That's a thing that I'm aware of and can do. You will find practitioners who will offer that. I guess I like that this is an option where we're not destroying or injuring the nerve itself. Because simply, like, if you don't want the phone calls coming to your house, cutting the phone line isn't maybe the best way, if that analogy makes sense.

So, that's a treatment that's out there as well, and it does get relief. This can be a repeated treatment. It's durable. And this is a way to get people active again. You know, oftentimes people who are suffering from arthritis are also trying to manage their weight, and it's a terrible feedback loop to be stuck where you know you want to be active, but you can't because you're in pain. And so, to be able to get to those ends, you know, being able to get active again to control your symptoms is really what I hope to offer for people.

Now, in the space itself for embolization, there's different agents that people are working on and using. And around the world, different agents have been used. This is an area of active research. There is some standards that have been working very well and have been reported now for several years that work really well. Some are very small medical-grade plastic, essentially. There's also a type of antibiotic that has a crystal is the one that I've been liking using here. And there's a lot of different agents actually out there that people have been using. But it's refining the technique and the technique itself of plugging the blood vessels with probably any number of different types of agents is what seems to get a good effect for people.

Host: Sure.

Dr. Scott Santeler: I don't want to present things too far ahead or on the bleeding edge of technology and technique. But this has shown such good results in the knee that it's also been applied to other areas of musculoskeletal inflammation. So, people are seeing good results from the shoulder. People are seeing plantar fasciitis, there's some preliminary studies that people have been doing that; tennis elbow. So, areas of active joint inflammation or musculoskeletal stuff are all areas of active interest, and I think that we're only going to see this technique employed more and more to more and more people's benefit.

Host: Yeah, as, we've established here, lots of folks are out there suffering, right, around the world. We want treatment options before we get to talking with you and others about replacements. And so whether it's GAE or some of the other stuff that's on the horizon, it sounds like, you know, there's some relief available today and in the future. It's all good stuff. Thank you so much.

Dr. Scott Santeler: Sure. Thank you.

Host: For more information and to get connected with one of our providers, please visit carle.org. And that wraps up this episode of Expert Insights with the Carle Foundation Hospital. I'm Scott Webb. Stay well.