Periarticular Embolization as an Alternative Treatment for Surgery-Ineligible Patients with Hip Osteoarthritis: A Prospective Comparative Study

Background/Objective: Hip osteoarthritis (HOA) is a major source of pain and disability worldwide. Although total hip arthroplasty (THA) provides substantial symptomatic improvement, a subgroup of patients remains ineligible because of severe comorbidities, frailty or elevated perioperative risk. Conservative treatments provide only temporary symptom control and transarterial periarticular embolization (TAPE) has emerged as a minimally invasive intervention targeting abnormal periarticular hypervascularity and inflammation. The aim was to compare clinical outcomes of TAPE and conservative care (CC) in patients with symptomatic HOA considered unsuitable for THA. Methods: A prospective non-randomized two-centre cohort study included consecutive adults aged ≥60 years with symptomatic HOA and baseline visual analogue scale (VAS) pain scores over 40. Patients were managed with either TAPE or structured CC. The primary endpoint was change in VAS pain score from baseline to 6 months. Secondary outcomes included Lower Extremity Functional Scale (LEFS), Timed Up-and-Go (TUG) and analgesic use. Patients were evaluated at baseline, 1, 3 and 6 months. Results: A total of 81 patients were screened, 69 were enrolled and 62 were included in the complete case longitudinal analysis. Baseline symptom severity was greater in the TAPE group, with higher VAS scores (73.6 ± 12.5 vs. 63.7 ± 14.1; p = 0.003) and lower-joint space width (1.37 ± 0.79 vs. 2.07 ± 0.89 mm; p < 0.001). The reduction in pain occurred during the first three months following embolization, after which symptom trajectories stabilized. Mean VAS pain in the TAPE group decreased from 73.6 ± 12.5 at baseline to 55.4 ± 13.0 at three months and 56.8 ± 13.6 at six months. LEFS improved in both groups throughout follow-up. Conclusions: TAPE was associated with symptom improvement and short-term safety in a small cohort of surgery-ineligible patients with HOA. The observed benefits appeared greatest within the first three months.