Date: 07 March 2019
A Berkshire woman with osteoarthritis of the knee is able to walk without limping after undergoing a new treatment as part of a European first study in the NHS.
Linda Skilton, 65, from Crowthorne, underwent the procedure for osteoarthritis of the knee on 29 January at the Royal Berkshire Hospital, Reading.
Osteoarthritis is a condition where the protective cartilage on the ends of the bones deteriorates, causing problems moving the joint. This leads to pain caused by inflammation and the growth of abnormal new blood vessels. It occurs mostly in older people.
Painkillers can be used to treat the symptoms of mild cases, however surgery to replace the knee may be needed in severe cases.
Researchers in Reading want to find treatments for patients with mild-to-moderate osteoarthritis pain for which painkillers have not worked.
The GENESIS study is looking at injecting tiny plastic beads - the size of a grain of sand - into the abnormal blood vessels in the knee to block the blood supply to the inflamed tissues.
The procedure, called geniculate artery embolisation (GAE), involves positioning a plastic catheter tube into the knee through a pinhole incision in the groin. X-rays are used to position the catheter into the arteries before the plastic beads are injected through it.
A similar study in Japan found a 75 percent reduction in pain over a four year period.
The study is the first to use this technique for osteoarthritis pain in Europe. It is being led by Dr Mark Little, Consultant Interventional Radiologist at Royal Berkshire NHS Foundation Trust and Visiting Professor at the University of Reading, with funding from Merit Medical and support from the National Institute for Health Research (NIHR).
Mrs Skilton was diagnosed with osteoarthritis in May 2016. She said: “I was having problems with my left knee; a lot of swelling, a lot of fluid, limited mobility.
“I was given cortisone injections which made it settle for a while, but it flared up again a year later when I was using some equipment at the gym.
“For the past couple of years, I haven’t been able stand for too long because it got so sore and swollen and I couldn’t keep it bent or straight for any length of time either, which made sleeping difficult.
“The pain in my knee has had an impact on everything I do: household chores, as well as my regular games of golf. The problem has even had an impact on my choral singing, as we’re required to regularly stand and sit when rehearsing and performing.”
Mrs Skilton, Ladies’ Captain for East Berkshire Golf Club, said: “The pain I experience when walking means I’ve been having to use buggies around the golf course for the past 12 months, which has been costing me a fortune.
“I can only describe the pain as being like a permanent toothache; just a dragging, gnawing pain that you can’t get any relief from.
“It’s made me feel very vulnerable and I don’t like that. I’ve got six young grandchildren and I like going out with them, I like being able to play with them, but when I’m in constant pain I just find I can’t cope with it anymore.”
Mrs Skilton volunteered for the study after she was told about it by her orthopaedic surgeon, Mr Edward Tayton, at the Royal Berkshire Hospital in September.
She said: “I told him my pain was getting worse and asked what my options were. He explained that I was now at the point where I needed a half knee replacement but asked if I would be interested in taking part in a new clinical trial.
“After he explained it to me, I quickly said yes, because it seemed to offer the chance of being pain free, without invasive surgery.
Mrs Skilton said of the procedure: “I only felt the initial cut to get to the artery, which was no worse than a paper cut.
“I was expecting some feeling of pushing and pulling, but I didn’t feel anything at all.
“Since the procedure, I can feel day-to-day that my knee is improving. I can easily walk up the stairs for the first time in years. I’m delighted with the outcome.”
Participants are given questionnaires six weeks, three months, one year and two years after the procedure to see if it has had a lasting effect on their pain.
Osteoarthritis is the most common type of arthritis, affecting nearly 9 million people in the UK.
Prior to the procedure, Mrs Skilton was given an MRI scan of her brain and questionnaires to assess her pain threshold at the University of Reading.
Richard Harrison, who runs these tests, said: “We understand that pain is one of the biggest barriers to successful outcomes following surgery. By using the latest scanning technology and psychological assessment, we hope to identify specific traits that predict poor surgical outcome and try to ultimately develop tools to improve outcomes.”
Dr Mark Little, who is leading the study, said: “If the results of this study and future studies confirm the Japanese data, then geniculate artery embolisation is a potential game changer for the treatment of osteoarthritis. Performed under only local anaesthetic, the procedure takes about one hour and patients go home the same day. It is truly minimally invasive.
“If you can get patients off high-dose painkillers who are struggling with mobility and unable to work, it has a massive impact on their health and quality of life.
“Linda is clearly very active and if we can keep her playing golf, then that will have a profound impact on her social interactions with friends, improve her happiness, and wellbeing, and give her back her independence.”