Prof. Thomas J. Vogl, M.D., Ph.D., is a leading specialist in interventional radiology, radiation therapy, and neuroradiology. As director of the Institute for Diagnostic and Interventional Radiology at the University Hospital of Johann Wolfgang Goethe University in Frankfurt am Main, he brings extensive expertise and experience to his work. Prof. Dr. Vogl is particularly well-known for his cutting-edge advancements in medical imaging and intervention, including the angiography robot, which enables precise and minimally invasive tumor treatment. His innovative therapeutic approaches, such as the development of the 3D camera for computed tomography, have led to significant advances in radiological care and offer improved image quality with a reduced radiation dose.
His extensive research and numerous publications reflect not only his deep expertise but also his commitment to continuously improving medical care. Prof. Dr. Vogl has made significant contributions to optimizing imaging and tumor treatment procedures and is internationally recognized for his expertise. Through his dedicated leadership and interdisciplinary collaboration within the hospital, he promotes comprehensive, high-quality patient care. His team benefits from his knowledge and his willingness to engage in professional exchange, which contributes to the continuous advancement of medical standards.
In his role as head of the institute and in his capacity as part of the collaboration with the German Football Association, Prof. Dr. Vogl is setting new standards in the medical care of professional athletes and in scientific research. His many years of experience and dedication are reflected in the high quality of care and the significant advances achieved under his leadership. The editorial team of the Leading Medicine Guide spoke with Prof. Dr. Vogl to learn more about joint embolization, a form of therapy that is still relatively new in Germany.
Joints play a crucial role in the mobility and flexibility of the human body. They enable us to perform everyday activities by connecting bones and ensuring smooth movement. Joint wear and disease, particularly in the shoulder, hip, and knee, are common problems that can significantly impair quality of life. These joints are especially susceptible to wear and tear because they are under constant strain and are often subjected to heavy loads. The treatment of joint disorders in the shoulder, hip, and knee requires a nuanced approach, as each joint region presents specific challenges and needs. Given the wide range of possible treatment options, it is important to find tailored solutions that both alleviate symptoms and address the underlying causes of the conditions. Therapeutic options range from conservative measures—such as physical therapy, medication for pain management, and targeted exercises designed to improve mobility and reduce pain—to more invasive procedures, including minimally invasive procedures and surgical interventions. In recent years, a procedure known as joint embolization has also proven effective.
Joint embolization is a medical procedure used in interventional radiology to treat certain joint conditions.
“Embolization itself is, in the broadest sense, an established procedure and was originally developed to stop bleeding. This is a minimally invasive procedure in which blood vessels are occluded, for example, in cases of traumatic injuries, gastrointestinal bleeding, or following surgical procedures. From this, another method has evolved in which conditions such as tumors are embolized, and it is now also used for gynecological or urological conditions—for example, with uterine fibroids or an enlarged prostate—to reduce blood supply. For several years now, the embolization procedure has been used to reduce inflammation in joints caused by osteoarthritis. To do this, small blood vessels are occluded wherever they are located near the sites of inflammatory changes in the joints, such as the synovial membrane. The resulting reduction in blood flow causes swelling and irritation to subside, thereby also alleviating the patient’s pain. This is often combined with anti-inflammatory medications to further reduce the inflammatory response. Embolization helps with osteoarthritis and cartilage degeneration, and in principle could be applied to all joints. It is most effective for the knee, hip, and shoulder. It is also possible for osteoarthritis of the foot, but there isn’t much experience with this yet,” explains Prof. Dr. Vogl at the beginning of our conversation.
Joint embolization can be used to treat various conditions:
Osteoarthritis: In cases of advanced osteoarthritis, joint embolization can help alleviate pain and improve joint function by reducing the pain caused by inflammation.
Synovitis: This inflammatory condition of the synovial membrane can be specifically treated with embolization to reduce inflammation.
Tumors: In some cases, joint embolization can also be used to treat tumors affecting the joint, to reduce blood flow to the tumors and control their growth.
Injuries: For certain joint injuries that lead to chronic pain or inflammation, this method can help relieve pain and improve joint function.
The preparation and performance of tape joint embolization in clinical practice require careful and comprehensive planning to ensure that the procedure is both safe and effective.
Prof. Dr. Vogl explains: “Comprehensive diagnostics are necessary for planning a joint embolization. The extent of osteoarthritis must be known, and all conservative therapies—such as physical therapy and pain medication—must have been exhausted. If the patient still experiences pronounced clinical symptoms, including pain, then the procedure is discussed. Here at the hospital, we also always require a contrast-enhanced MRI to see exactly where the osteoarthritis, the capsular changes, and the joint space are located. And we then use these images for the actual embolization procedure. The exact start of embolization therapy depends somewhat on wait times. Two things must also always be clarified: First, consultation with the treating orthopedic surgeon, internist, and rheumatologist; and second, in addition to the MRI, blood test results are needed to evaluate the inflammatory markers. Finally, the issue of insurance coverage must be clarified. For privately insured patients, the costs of therapy are covered in all cases; for those with public health insurance, an inquiry must be made. We provide the patient with a cost estimate for this purpose so they can obtain a statement of coverage. As for the duration of treatment, the therapy is typically provided on an outpatient basis. In this respect, this form of therapy fits well with the current concept of “shifting toward outpatient care” pursued by the Federal Ministry of Health.”
In tape joint embolization, a special type of substance is injected into the affected joint to selectively block certain blood vessels and thereby reduce blood flow to the diseased or damaged areas. This procedure aims to alleviate the symptoms of joint disease and slow the progression of the condition.
“During the procedure, the patient lies on the treatment table. In the case of knee treatment, for example, the leg is punctured at the groin, and a small catheter is inserted to locate the vessels supplying the synovial membrane using three-dimensional angiography. The anti-inflammatory medication and small beads are then injected into the vessels. The beads are typically made of biocompatible materials. We use acrylate-based polyethylene beads (resin); they are 100–200 μm (micrometers) in size, are preformed, and must be injected with great precision into the vessels supplying the inflamed area. “The beads remain in place and are broken down by the body’s own cells over the course of 2–4 years,” said Prof. Dr. Vogl, explaining the details of the therapy.
During the treatment, the position of the catheter and the distribution of the embolization material are continuously monitored to ensure that the substance acts exactly where it is needed. Once the injection is complete, the catheter is removed and the puncture site is closed. The patient is then monitored for a short time to ensure that no acute complications arise. Typically, the patient can go home relatively quickly after the procedure.
“Many patients come in for a single treatment; some return after 4–5 years if their osteoarthritis progresses. Patients notice a significant improvement in their pain as early as about 3 weeks after the procedure, and after about 3 months, we can speak of a therapeutic outcome. In stage IV osteoarthritis, embolization is not effective—that is, when it’s essentially cartilage rubbing against cartilage. Even if an MRI shows beforehand that there is no thickening of the synovial membrane and the patient is, so to speak, rubbing bone against bone. However, the procedure has become well established and is also successful. Here at our clinic, we perform 2–3 treatments per week, and the trend is rising sharply. More and more radiologists are also adopting this form of therapy, so that it is now offered in many hospitals,” explains Prof. Dr. Vogl, adding: “It’s not a 100 percent effective method, but about 85% of patients are very satisfied, about 10% feel better, and 5% of patients notice no difference.”
The long-term results of tape joint embolization can vary from patient to patient. For many patients, pain relief and improved joint function can last from several months to years. The duration of the results depends on the individual’s response to the therapy, the type of joint disease, and the patient’s overall health. To ensure long-term results, regular follow-up care is recommended. This includes scheduled follow-up visits to monitor progress and make adjustments to the treatment as needed. Should symptoms return or if the patient does not experience the expected relief, additional treatments or alternative therapeutic strategies may be considered.
Thank you very much, Professor Dr. Vogl, for sharing your insights into this promising therapy!
