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DEAR DR. ROACH: I'm a 74-year-old male who's in otherwise excellent health. However, I have severe arthritis in my knees to the point where it keeps me up at night. I keep reading about this treatment called GAE (genicular artery embolization), and since I only have about a good 10 years or so left on this planet, I wanted to know your thoughts on this treatment. A full knee replacement requires a year of physical therapy, so I'd rather not do one.
-- P.C.
ANSWER: GAE uses biologically inert material (absorbable gelatin microspheres) to block specific abnormal blood vessels in the knee, which are branches of the geniculate artery. This treatment reduces inflammation and some of the growth factors that ultimately lead to increased pain. GAE is currently considered for people who haven't had a good response to standard treatments and for people who are either unwilling to get or can't get a knee replacement.
The evidence showing effectiveness includes "before" and "after" studies that display a very significant reduction in pain, with relief lasting up to two years. However, very stringent studies, where GAE was compared to a "sham" procedure (which was identical except for embolization), showed little to no benefit. This suggests that much (or all) of the benefit from GAE may be due to people expecting a benefit.
I'd be cautious about the two assumptions that you seem to be making. The first is that you may have more good years than you expect. A knee replacement may ultimately lead to a greater, longer-lasting benefit.
The second is that the duration of physical therapy following a knee replacement is typically two to three months. Though, even after supervised physical therapy is over, surgeons and physical therapists recommend continued strength and flexibility exercising at home. This recommendation goes for people with severe osteoarthritis of the knee regardless of treatment.
DEAR DR ROACH: I'm a recently retired physician who worked with an elderly population in the home health setting. On a recent trip, I heard a story of an older man who fell on some steps while traveling in Europe. He had bleeding due to a forehead laceration. His wife said that he was a bleeder because he was anticoagulated.
The bleeding was controlled with pressure and dressing the wound. He wasn't seen in an emergency room at that time. A few days later, he was admitted to a hospital with a decreased level of consciousness and was on life support with intracranial bleeding. It was likely that he wouldn't survive.
Please help get the word out to patients, families, and the general population that being over the age of 65 and anticoagulant use are indications for an ER evaluation and brain imaging with a CT scan to rule out bleeding in head trauma.
-- Rick Beam, MD