Two weeks before turning 50, I found myself staring at the growing bump on my thumb joint, wincing as I tried to open a jar. Early-onset osteoarthritis had become my unwelcome companion. More than 30% of women over 50 develop painful thumb osteoarthritis according to the Framingham Osteoarthritis Study - a statistic I was destined to join slightly ahead of schedule. My father faced the same battle, his hands gradually losing function despite endless rounds of treatments. Our shared experience isn’t unique; millions search for solutions beyond conventional approaches of anti-inflammatory gels, steroid injections, and expensive stem cell or PRP treatments that aren’t covered by insurance and remain largely experimental.
This personal journey led me to discover hand embolization, an innovative treatment that targets the source of arthritis pain rather than just masking symptoms. During a recent episode of The Heart of Innovation, I brought together two specialists with very different perspectives on treating hand osteoarthritis: Dr. Yuji Okuno, creator of the groundbreaking Okuno Method of embolization from Japan, and Dr. Asaf Kadar, an orthopedic surgeon from Canada specializing in hand surgery, along with a guest co-host, Dr. Michael “Misha” Ginsburg, an Interventional Radiologist in the U.S. who specializes in embolization procedures.
The Current Landscape: From Conservative Management to Surgical Innovation
Before diving into the biggest breakthrough in minimally invasive approaches, it’s important to understand the current methods of treatment and recent surgical advances. Dr. Kadar, who leads research at the HULC bioengineering lab developing new suspensionplasty hand and digit devices, provided valuable insights into the conventional treatment path.
“Osteoarthritis at the base of the thumb is a disease of cartilage like any osteoarthritis,” Dr. Kadar explained. “Basically two bones rubbing together and you have bone-on-bone contact which is a pain generator.”
The standard treatment ladder begins with the most conservative approaches. “Usually patients in the very early stage will be treated with pain medications or anti-inflammatory drugs as simple as Advil,” Dr. Kadar noted. “The next step of that treatment ladder usually would be hand therapy.”
Hand therapy itself has seen significant innovation, including 3D-printed braces. “It’s as simple as taking a camera from your phone, scanning your hand, and then the company will print out your 3D printed brace,” Dr. Kadar explained. “Studies have shown some improvement over traditional braces that you’re buying at Walgreens.”
If these conservative measures fail, physicians typically move to injections, “usually steroid injections into the joint,” which Dr. Kadar recommends doing with imaging guidance for accuracy.
The final step in traditional treatment is surgery, and this is where some of the most exciting developments are happening. “I think there’s going to be a huge change in the way we treat this problem in America and Canada in the next two or three years,” Dr. Kadar shared. “Things have begun in Europe and have been progressing there for the last 10 years, which is basically replacing that joint.”
Currently, the standard surgical approach doesn’t actually replace the arthritic joint. “Right now we’re not replacing that joint, which is arthritic. We’re just removing part of it, which works,” Dr. Kadar explained. “But I think replacing the joint is the way of the future here.”
This emerging approach to joint replacement represents a significant shift in surgical treatment. “That surgery has had a very bad reputation in the past, but now new technology has really improved the outcome,” Dr. Kadar noted.
Even with these surgical breakthroughs, Dr. Kadar was interested in learning more about the next wave of minimally invasive techniques, as was I. When you have so many treatment options, as Dr. Kadar pointed out, “that means that you don’t have one good option. We don’t have 500 ways to replace a hip joint because there’s one surgery that works. The thumb is not the case.”
From Cancer Treatment to Arthritis Relief: The Birth of the Okuno Method
Dr. Okuno’s path to revolutionizing arthritis treatment began in oncology, not orthopedics.
“The idea of embolizing inflammatory vessels started around 2007 or 2008,” Dr. Okuno explained. “At that time, I was treating cancer using catheters.”
While treating cancer patients, he noticed something fascinating: arthritic joints contain abnormal blood vessels similar to those in tumors.
“Inflammatory tissue contains lots of abnormal blood vessels,” he explained. “Just like in cancer treatment, we realized we could reduce inflammation by blocking these inflammatory vessels.”
This observation led to the Okuno Method—using temporary embolic materials to target inflammatory blood vessels while preserving normal circulation. It’s fundamentally different from traditional treatments that often just mask symptoms.
The Revolutionary Okuno Method: A Minimally Invasive Approach
What makes the Okuno Method particularly groundbreaking is its simplicity and effectiveness. Originally, Dr. Okuno performed the procedure by inserting a catheter through the femoral artery in the groin and guiding it to the hand—a time-consuming process requiring expensive equipment. However, the technique has evolved significantly:
“We now use ultrasound to guide a 27-gauge needle—very small—directly to the radial artery,” Dr. Okuno explained. “We inject temporary embolic material that affects the whole hand.”
This refined approach has transformed the treatment into a remarkably quick procedure:
“It takes one to two minutes,” Dr. Okuno noted. “And the needle size is very small. It’s minimally invasive—the invasion is smaller compared to direct injection using steroid injection.”
The embolic agent, imipenem (an antibiotic repurposed as a temporary embolic material), costs only one or two dollars per treatment, making this an economically viable option. The temporary nature of the embolization is key to its safety:
“Our temporary embolic agent recanalizes very fast—within 10 to 20 minutes, fingers return to normal color. It’s safe,” Dr. Okuno emphasized. “In Japan, we’ve done more than 5,000 cases per year for hand and finger osteoarthritis, and no one has developed tissue death.”
Clinical Success Rates and Treatment Timing
Unlike many treatments that serve as a last resort, Dr. Okuno advocates for early intervention with embolization: “We recommend embolization even for patients who have never received a steroid injection. Every physician can agree that corticosteroid is damaging to the joint cartilage. We don’t want to do that.”
The clinical results are impressive. According to Dr. Okuno, “For the early stage and moderate stage, like ETHM grade one to three, the patients have a clinical success rate around 80 or 85% for two times injection. Two years later, the clinical success rate remains maintained at about 85%.”
This is particularly significant for patients in the early to moderate stages of osteoarthritis, as the procedure may help delay more invasive surgical interventions.
“In the early stage of thumb base inflammation, the patient feels pain in daily life and stiffness. The patients already have inflammatory vessels, but the cartilage is still remaining. That is a good phase to start,” Dr. Okuno explained. “If the patients have end-stage osteoarthritis and the cartilage is totally lost and the bone marrow is disruptive, in those cases, we cannot contribute a lot.”
Orthopedics Meets Interventional Radiology: The Real Conversation
During our discussion, Dr. Kadar posed the questions many doctors would ask. The exchange revealed the natural tension between established practice and innovation.
When Dr. Kadar raised concerns about injecting materials into the fingertips, noting that medical students are taught this could lead to tissue death, Dr. Okuno addressed these concerns directly:
“Please notice that our agent, temporary embolic agent, is recanalized very fast, so within 10 minutes or 20 minutes, [fingers] turn to normal color. So it’s totally safe,” he explained.
Dr. Kadar’s initial skepticism gradually shifted toward interest as the conversation progressed. When asked what would convince him to adopt the technique, he was candid: “I’m a man of evidence. I need to see the data. It sounds like it’s coming soon. Once it’s there, I’ll be a first adopter.”
The Growing Adoption of the Okuno Method
The technique is rapidly gaining traction in Japan, where it has been adopted by numerous medical professionals:
“In Japan, 150 orthopedic clinics have introduced this technique,” Dr. Okuno noted. “Any physician who can use ultrasound can learn it.”
To further promote this innovative approach, Dr. Okuno has established the Venti meeting, an international congress focused on musculoskeletal embolization techniques scheduled for November in Tokyo. This gathering will allow physicians interested in learning the technique to observe and practice under expert guidance.
Beyond Steroids and PRP: A New Paradigm in Treatment
When I mentioned my experience with PRP (platelet-rich plasma) and stem cells, Dr. Okuno offered his perspective: “Embolization reduces inflammation better than PRP or stem cells. Those treatments mainly reduce inflammation too—they’re not truly regenerative.”
Dr. Kadar agreed: “There’s no good evidence supporting PRP over steroids or hyaluronic acid. Theoretically, it should be better, but we lack the clinical evidence.”
For the millions struggling with hand osteoarthritis, these developments offer real hope. The conversation between these two specialists—one pioneering a new approach, the other representing established practice—shows how medical innovation actually happens: through questioning, evidence, and cautious adoption.
A Paradigm Shift in Treatment Algorithms
The Okuno Method represents a potential paradigm shift in how we approach osteoarthritis treatment. By targeting the abnormal blood vessels that contribute to inflammation rather than just managing symptoms, this approach addresses one of the underlying mechanisms of pain and joint deterioration.
The traditional treatment ladder for hand osteoarthritis typically progresses from pain medications and anti-inflammatories to hand therapy, steroid injections, and eventually surgery. The Okuno Method offers a minimally invasive alternative that could be positioned earlier in the treatment sequence, potentially delaying or even preventing the need for more invasive procedures.
As healthcare advances, these cross-specialty conversations drive progress. For anyone suffering from vascular disease, heart conditions, or osteoarthritis, this kind of medical dialogue brings us closer to better treatments.
1 Haugen IK, Englund M, Aliabadi P, et al. Prevalence, incidence and progression of hand osteoarthritis in the general population: the Framingham Osteoarthritis Study. Ann Rheum Dis. 2011;70(9):1581-1586.
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