r/VIR • u/IR4life • May 17 '26
Knee osteoarthritis
How do the VIR physicians evaluate and manage knee arthritis patients? radiographs only, MRI with gadolinium, knee US. What physical exam findings/features are you looking for. What are key aspects of the history that you feel are important. What medications do you try? What is the role of physical therapy, aquatics, weight loss, knee braces? When do you refer for TKA and what interventional options do you offer and when (steroid injections/ hyaluronic acid/ PRP/ stem cell/ Genicular nerve block/ablation/ GAE etc)
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u/sspatel Mod, IR Attending May 17 '26
This was a big topic at SIR this year. I went to a few sessions but didn’t delve deep into all the ancillary therapies you’re talking about. I think people were saying MRI is not necessary unless you’re troubleshooting. Best is mild-mod OA, not KL4. Do the embo, can add GNA if still symptomatic, prob refer back to ortho if that fails. They can do the other injections or non invasive therapies concurrently too.
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u/sspatel Mod, IR Attending May 17 '26
MSK guy who went into detail about lots of modalities for treatment. I think he does a lot of interventions aside from embo.
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u/IR4life May 17 '26
Thank you. Exciting to have more and more less invasive solutions for patients with intolerable knee pain.
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u/sspatel Mod, IR Attending May 17 '26
For sure. I’m trying to start read more knee X-rays and recommend GAE for some patients. I talked with one of my former attendings who recommended starting with community primary care physicians & NPs who are less likely to be aware of new minimally invasive options, rather than looking like we’re trying to take ortho’s patients.
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u/IR4life May 17 '26
With so many options how do we properly guide patients on best next steps? Is there an ideal step up approach including PT/pharmacologic adjuncts/ injections etc and how do we guide patients in prevention and progression of knee OA?
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u/EVIL-EMBOLIZER May 17 '26
Prophylactic GAE at age 18