TAPE therapy (transarterial periarticular embolization) is primarily used for chronic joint diseases caused by degenerative changes or inflammatory processes.
“TAPE stands for transarterial periarticular embolization. Sometimes it is also simply referred to as TAE, meaning transarterial embolization, but TAPE actually describes the procedure more precisely. What is fascinating is that you can help people by deliberately occluding blood vessels. Normally, such arterial procedures are used to stop bleeding or treat tumors. Here, however, medications are delivered directly into the joint via the blood vessels. By occluding certain vessels, the proliferating synovial membrane—the synovium—as well as existing inflammatory irritations are cut off from the blood supply. This leads to an improvement in symptoms. The procedure is not suitable for acute inflammation or tumor diseases, but rather for chronic joint damage: cartilage defects, old ligament injuries, or general inflammatory irritation within the joint. These irritative processes are interrupted by embolization because blood flow is reduced. Many patients are then able to move better again, become more mobile overall, and experience a significant improvement in their quality of life,” Prof. Dr. Dr. Vogl explains at the beginning of our conversation and continues:
“Typically, patients come to us whose joints have been steadily deteriorating over a longer period of time but who do not yet want joint replacement surgery. One example: a 60-year-old patient with severe knee osteoarthritis. If the procedure allows him to walk well for one or two additional years, the timing of a prosthesis can be delayed. That is important, because if you receive an artificial knee at 60, it is often worn out by 70—and prosthesis replacement at an older age is always significantly riskier. That is exactly what we try to avoid. Most commonly, the procedure is performed on the knee; worldwide, this is the main area of application. This is followed by the hip joints. Elbows with severe osteoarthritis, wrists, or feet are treated less frequently—but in principle, anywhere soft tissue reactions occur. This can be well controlled because highly perfused areas absorb a lot of contrast medium, and these ‘cloud-like’ regions can be selectively reduced using microspheres. There are two variants: permanent particles that are slowly degraded over many years, and newer temporary particles that completely dissolve through natural processes in the blood within three to six months. Many patients find this very appealing. The effect is essentially the same, but with temporary particles it is not yet known whether the effect remains equally stable in the long term, as they have not been in use long enough. And it is important to note: the procedure does not heal the joint. The cartilage remains damaged. But the pain decreases, quality of life improves, and patients can use their own joint for longer.”
TAPE is often used when conservative measures such as physical therapy, pain medication, or intra-articular injections are no longer sufficiently effective, but surgery is not yet necessary or not desired. The method is particularly advantageous for patients seeking a joint-preserving alternative, as the procedure leaves the joint itself unchanged and is performed in a minimally invasive manner.
“As a rule, the patient contacts us in advance, either through an orthopedic specialist or directly. Initially, we clarify in a telephone consultation whether the procedure is fundamentally an option. If the patient then presents in person, we create three-dimensional imaging, usually an MRI including vascular visualization. We assess whether the vessels are patent and whether the procedure is technically feasible at all. Subsequently, the issue of cost coverage must be clarified—meaning which health insurance provider is responsible. Depending on the insurance, approval may be required. We support patients throughout this process. Some insurers require a detailed justification or cost hypothesis before granting approval. This must be reviewed on a case-by-case basis. After the examination, everything is discussed again with the patient, including benefits and risks, and a joint decision is made as to whether the procedure will be performed. This can take place either on the same day or at a later date. The procedure itself takes about one hour and is generally painless. Afterward, we observe the patient for another four hours. If everything is unremarkable, the patient can leave the clinic the same day,” Prof. Dr. Dr. Vogl explains.
Conservative therapies such as painkillers, anti-inflammatory medications, or injections usually provide only symptomatic relief without directly addressing the underlying cause of pain, while surgical interventions are significantly more invasive, require longer recovery times, and may be associated with higher risks. TAPE, on the other hand, acts directly on the pathological vessels, is tissue-sparing, preserves the joint, and can be used both as a standalone therapy and in combination with other measures. Through this direct, minimally invasive treatment, pain can often be effectively reduced and joint function improved without the need for surgery.
TAPE is not suitable for patients with severely destroyed joints, such as those with advanced osteoarthritis or massive cartilage loss, since pain in these cases is primarily caused by structural damage. Infected or acutely inflamed joints as well as systemic infections also rule out the procedure. In addition, coagulation status and vascular conditions must be suitable—severe coagulation disorders, uncontrolled anticoagulation, or certain vascular diseases increase the risk. In cases of severe obesity or unfavorable anatomy, vascular access may be more difficult. Fundamentally, TAPE does not replace surgery when a prosthesis or another intervention is clearly necessary, for example in cases of instability, severely restricted function, or large defects.
The TAPE treatment process is well structured for patients, minimally invasive, and usually performed on an outpatient basis. Prior to the procedure, thorough preparation is required, including a detailed medical history, physical examination, and imaging procedures such as ultrasound, MRI, or CT to accurately assess the affected joint and vascular anatomy. Potential risks, such as coagulation disorders or comorbidities, are also evaluated, and the patient is informed about the procedure, possible side effects, and aftercare. Adjustment of anticoagulant medication is often necessary.
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On the day of treatment, the patient first receives local anesthesia. A thin catheter is then inserted via an artery in the groin or arm and advanced under X-ray guidance to the small vessels surrounding the affected joint. The inflammation-promoting vessels are selectively occluded with tiny particles. The patient remains awake during the procedure or receives light sedation; general anesthesia is not required. After removal of the catheter and a short observation period, the patient can usually return home the same day.
Prof. Dr. Dr. Vogl comments on this: “During the procedure itself, current blood values are required, and a very small catheter is placed and precisely guided to the correct location. The procedure usually takes between half an hour and an hour because working on very small vessels is extremely detailed. With sufficient experience, however, it is quite manageable. In principle, the method is aimed at patients who experience significant limitations in their quality of life due to joint osteoarthritis but are not yet ready or suitable for total joint replacement—whether because they are too young, do not want it yet, or the damage has not progressed that far. The procedure fits precisely into this gap. After all, even with a prosthesis there is no guarantee of being completely symptom-free afterward. Many would approach it in the same way: first try to regain quality of life through embolization. A prosthesis can always be implanted later—it is not going anywhere, and today it can be done almost anywhere. The method itself originated in a similar context to prostate or fibroid embolization,” and he concludes our conversation by explaining what happens afterward:
“A bit of rest does no harm, and physical strain should initially be reduced. We have never experienced serious complications in several hundred patients. At most, there may be some minor bleeding at the puncture site in the groin, but fortunately no serious problems have occurred so far. As for the effect, most patients report that initial improvement begins after three to four weeks. The maximum effect is reached after about three months, and the benefit usually lasts one to two years—depending on the range of motion and how well the patient participates. If symptoms worsen again, the procedure can in principle be repeated. It should not be done indefinitely, but two to three times is certainly possible. Especially for younger patients who develop knee problems early and wish to delay a prosthesis for as long as possible, this is a very attractive option.”
Thank you very much, Professor Dr. Dr. Vogl, for the insightful overview of the promising TAPE treatment!
- Specialist in radiation therapy–radio-oncology, neuroradiology, and interventional radiology in Frankfurt am Main and recognized as one of Europe’s leading experts in interventional radiology.
- Performs advanced procedures such as transarterial regional chemoperfusion, tumor ablation techniques, and embolizations.
- Innovator in medical technology, known for developing an angiography robot to improve tumor diagnostics.
- Focus on minimally invasive treatments, including the use of state-of-the-art 3D camera technology and AI.
- Committed to patient-centered care, quality assurance, and interdisciplinary collaboration.
- Official cooperation partner of the DFB, specializing in the medical care of professional athletes.
- Author of numerous standard reference works, recipient of multiple scientific awards, and member of various international professional societies.
