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Applied Sciences
Volume 16
Issue 1
10.3390/app16010361
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Review

Chronic Pain Following Unicompartmental Knee Arthroplasty: A Narrative Review and Illustrative Case Report on Genicular Artery Embolization Using Imipenem/Cilastatin

by
Guido Bocchino
1,2,*,
Riccardo Totti
1,
Rocco Maria Comodo
1,3,
Chiara Barbieri
1,
Alessandro El Motassime
1,
Davide Messina
1,
Vincenzo De Santis
1,3 and
Matteo Cappucci
1,3
1
Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy
2
Institute of Biomechanics, Paracelsus Medical University (PMU), 5020 Salzburg, Austria
3
Mater Olbia Hospital, SS 125 Orientale Sarda, 07026 Olbia, Italy
*
Author to whom correspondence should be addressed.
Appl. Sci. 2026, 16(1), 361; https://doi.org/10.3390/app16010361 (registering DOI)
Submission received: 15 December 2025 / Revised: 26 December 2025 / Accepted: 28 December 2025 / Published: 29 December 2025
Review Reports Versions Notes

Featured Application

Genicular artery embolization (GAE) using Imipenem/Cilastatin may represent a valuable minimally invasive alternative for managing chronic pain after unicompartmental knee arthroplasty (UKA) when mechanical failure and infection are excluded. This technique can be applied in interventional radiology settings to reduce synovial hypervascularization and inflammation, offering durable pain relief in patients who are not eligible for revision surgery.

Abstract

Background: Chronic pain after unicompartmental knee arthroplasty (UKA) represents a significant clinical issue, often unrelated to mechanical causes and resistant to standard therapies. This work combines a narrative review and a case report to explore the pathophysiological mechanisms underlying persistent post-UKA pain and to propose genicular artery embolization (GAE) with Imipenem/Cilastatin (IPM/CS) as a novel minimally invasive treatment option. Methods: A comprehensive literature review was conducted to analyze current diagnostic and therapeutic approaches to chronic post-UKA pain, with emphasis on vascular and inflammatory mechanisms. Additionally, a patient with chronic lateral knee pain refractory to conservative management underwent selective GAE targeting hypervascularized genicular branches. Results: Following the procedure, the patient experienced substantial and sustained pain reduction, functional improvement, and no complications. The literature supports synovial neovascularization as a potential pain generator and confirms the safety of IPM/CS due to its transient embolic effect and preservation of normal perfusion. Conclusions: The combination of literature review and clinical evidence suggests that GAE may represent a promising therapeutic alternative for chronic post-UKA pain. Further studies are needed to confirm its efficacy, long-term outcomes, and appropriate indications within this challenging clinical setting.
Keywords: genicular artery embolization; unicompartmental knee arthroplasty; chronic pain; imipenem/cilastatin; neovascularization genicular artery embolization; unicompartmental knee arthroplasty; chronic pain; imipenem/cilastatin; neovascularization

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MDPI and ACS Style

Bocchino, G.; Totti, R.; Comodo, R.M.; Barbieri, C.; Motassime, A.E.; Messina, D.; De Santis, V.; Cappucci, M. Chronic Pain Following Unicompartmental Knee Arthroplasty: A Narrative Review and Illustrative Case Report on Genicular Artery Embolization Using Imipenem/Cilastatin. Appl. Sci. 2026, 16, 361. https://doi.org/10.3390/app16010361

AMA Style

Bocchino G, Totti R, Comodo RM, Barbieri C, Motassime AE, Messina D, De Santis V, Cappucci M. Chronic Pain Following Unicompartmental Knee Arthroplasty: A Narrative Review and Illustrative Case Report on Genicular Artery Embolization Using Imipenem/Cilastatin. Applied Sciences. 2026; 16(1):361. https://doi.org/10.3390/app16010361

Chicago/Turabian Style

Bocchino, Guido, Riccardo Totti, Rocco Maria Comodo, Chiara Barbieri, Alessandro El Motassime, Davide Messina, Vincenzo De Santis, and Matteo Cappucci. 2026. "Chronic Pain Following Unicompartmental Knee Arthroplasty: A Narrative Review and Illustrative Case Report on Genicular Artery Embolization Using Imipenem/Cilastatin" Applied Sciences 16, no. 1: 361. https://doi.org/10.3390/app16010361

APA Style

Bocchino, G., Totti, R., Comodo, R. M., Barbieri, C., Motassime, A. E., Messina, D., De Santis, V., & Cappucci, M. (2026). Chronic Pain Following Unicompartmental Knee Arthroplasty: A Narrative Review and Illustrative Case Report on Genicular Artery Embolization Using Imipenem/Cilastatin. Applied Sciences, 16(1), 361. https://doi.org/10.3390/app16010361

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