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Genicular Artery Embolization: A Novel Treatment for Osteoarthritis‑Related Knee Pain

Posted On: July 16, 2025

See the Article by Dr. Jeremy Kim, Dr. Timothy Carlon, and Dr. Ray Norby published in MD Professional HERE.

Osteoarthritis (OA) of the knee is a common cause of pain and disability, particularly in an aging population. Treatment options range from non‑invasive therapies like physical therapy and oral medications to steroid injections and knee replacement surgery. While these interventions target symptoms or structural changes, an often underrecognized driver of pain is synovial inflammation, which appears early in OA development and correlates closely with pain.¹

As inflammation progresses, abnormal vascularity develops within the synovium, fueling further inflammation and discomfort. Genicular artery embolization (GAE) targets this neovascularity by selectively occluding abnormal vessels while preserving the main genicular artery branches. This approach reduces synovial blood flow, inflammation, and pain.

Minimally Invasive GAE Procedure

GAE is performed by an interventional radiologist under fluoroscopic guidance. A small catheter is inserted through a femoral or pedal artery puncture, and a microcatheter is advanced into the genicular branches supplying the inflamed synovium.

Arteriograms are obtained by injecting contrast, and the abnormal vessels are selectively embolized (Figure 1). Embolization can be performed using permanent microsphere particles or temporary agents such as imipenem‑cilastatin or lipiodol.² ³

The procedure is outpatient, performed under light sedation, and typically takes about one hour. Most patients resume normal activities the next day.

Safety, Efficacy, and Durability of GAE

Clinical evidence supports GAE as a safe and effective option for refractory OA‑related knee pain. Multiple multicenter trials, sham studies, and meta-analyses show significant improvements in:

  • Pain (VAS): 54% improvement at 1 week and 80% improvement at 2 years
  • Function (WOMAC): 58% improvement early and up to 85% at 2 years⁴ ⁵

GAE also reduces reliance on pain medications, with declines of:

  • 27% in opioid use
  • 65% in NSAID use
  • 73% in hyaluronic acid injection use⁴

For patients who respond well, benefits have been shown to last at least 2 years—substantially longer than steroid injections, which typically last months.⁶ ⁷ Patients who later undergo knee replacement do not experience increased complications related to prior embolization.

No severe or life‑threatening complications have been reported. The most common side effect is a temporary, self‑resolving skin color change. Minor puncture‑site hematomas occur less frequently.

Patients Who Are Candidates for GAE

Candidates include patients with:

  • Moderate to severe OA‑related knee pain not controlled by conservative therapy
  • Poor surgical candidacy for knee replacement
  • Personal preference to avoid or delay surgery

Contraindications include active infection, irreversible coagulopathy, and significant peripheral vascular disease.

Several multicenter trials continue to evaluate long‑term outcomes, ideal patient selection, embolic agent choice, and cost‑effectiveness. Standardized guidelines are expected as data grows.

Conclusion

Genicular artery embolization is a safe, minimally invasive, and effective treatment option for knee osteoarthritis in appropriately selected patients. It complements standard therapies such as anti‑inflammatory medications, physical therapy, injections, and knee replacement surgery.

GAE can improve quality of life, reduce the need for pain medications, delay surgery, and serve as a bridge for patients not yet ready for knee replacement. It is especially valuable for those with inadequate relief from conservative measures.

References

  1. Sanchez‑Lopez E, Coras R, Torres A, Lane NE, Guma M. Synovial inflammation in osteoarthritis progression. Nat Rev Rheumatol. 2022;18(5):258–275. doi:10.1038/s41584‑022‑00749‑9.
  2. Sapoval M, Querub C, Pereira H, et al. Genicular artery embolization for knee osteoarthritis: Results of the LipioJoint‑1 trial. Diagn Interv Imaging. 2024;105(4):144–150. doi:10.1016/j.diii.2023.12.003.
  3. Correa MP, Motta‑Leal‑Filho JM, Lugokeski R, Mezzomo M, Leite LR. GAUCHO trial—genicular artery embolization using imipenem/cilastatin vs. microsphere for knee osteoarthritis: A randomized controlled trial. Cardiovasc Radiol. 2022;45(7):903–910. doi:10.1007/s00270‑022‑03089‑z.
  4. Epelboym Y, Mandell JC, Collins JE, et al. Genicular artery embolization as a treatment for osteoarthritis‑related knee pain: A systematic review and meta-analysis. Cardiovasc Intervent Radiol. 2023;46(6):760–769. doi:10.1007/s00270‑023‑03422‑0.
  5. Torkian P, Golzarian J, Chalian M, et al. Osteoarthritis‑related knee pain treated with genicular artery embolization: A systematic review and meta-analysis. Orthop J Sports Med. 2021;9(7):23259671211021356. doi:10.1177/23259671211021356.
  6. Little MW, O’Grady A, Briggs J, et al. Genicular artery embolisation in patients with osteoarthritis of the knee (GENESIS) using permanent microspheres: Long‑term results. Cardiovasc Radiol. 2024;47(12):1750–1762. doi:10.1007/s00270‑024‑03752‑7.
  7. Okuno Y, Korchi AM, Shinjo T, Kato S, Kaneko T. Midterm clinical outcomes and MR imaging changes after transcatheter arterial embolization for mild to moderate radiographic knee osteoarthritis resistant to conservative treatment. J Vasc Interv Radiol. 2017;28(7):995–1002. doi:10.1016/j.jvir.2017.02.033.
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