Genicular Artery Embolization
Genicular artery embolization is a new, minimally invasive treatment for chronic knee pain from osteoarthritis, the most common type of arthritis of the knees, usually due to age-related changes, weight-bearing, and overuse.
What is Genicular Artery Embolization?
Genicular artery embolization (GAE) is a new, minimally invasive treatment for chronic knee pain caused by osteoarthritis. Osteoarthritis is the most common type of arthritis affecting the knees, typically due to:
- Age-related changes
- Weight-bearing stress
- Overuse
How Does the Procedure Work?
GAE works by blocking a small percentage of blood flow to the knee’s capsular arteries (synovium) to reduce inflammation.
- A small catheter is placed into the arteries supplying the knee.
- Small particles are injected into these arteries.
- This reduces excessive blood flow, which contributes to chronic inflammation.
- In osteoarthritis, much of the pain is due to inflammation, and the source of the inflammation or inflammatory cells from the synovial blood vessels.
- When patients have osteoarthritis, the body increases blood vessel formation, worsening inflammation and pain.
- GAE reduce a small portion of blood flow to the knee capsule,
decreasing inflammation and therefore stopping or markedly reducing inflammatory pain.
GAE as an Alternative to Surgery
This procedure is an alternative to knee replacement surgery for patients with moderate osteoarthritis who have not responded to conservative treatments.
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How quickly does it work?
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Pain relief usually begins within a few days.
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The full effects typically occur around 2 weeks.
What is Recovery Like?
Patients typically go home the same day shortly after the procedure.
Patients can walk on their own immediately after the procedure
Gradual return to activity is expected over the next few days.
Post-Procedure Care:
- Activity: We recommend limited activity for the first 24 hours
- Pain management: Post-operative pain medications are provided
- Monitoring the access site: We provide instructions to closely monitor for bleeding or infection at the catheter access/puncture site
- Physical therapy: Some patients may also benefit from rehabilitation exercises to optimize joint health.
How Much Pain Relief Can Be Expected?
Most patients experience greater than 50% reduction in pain scores as early as 3 days after the procedure.
Pain relief can last at least 1 year, and for many, over 2 years or longer.
Scientific Research on GAE Effectiveness
✔ A systematic review of 10 different studies showed:
- a 68-92% reduction in pain at 1 month,
- continued relief for at least 1 year (Taslakian B, et al., 2023).
Key Benefit: Other research supports GAE’s ability to reduce inflammation and improve knee function in mild to moderate osteoarthritis patients.
Are there risks?
GAE is considered a low-risk outpatient procedure, but like other vascular procedures, some risks exist.
Common and Minor Risks:
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Skin discoloration around the knee (occurs in ~12% of patients) but typically
clears within a few days.
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Mild soreness or swelling at the catheter site, usually resolving within a few days.
Rare but Possible Risks:
✔ Bleeding, blood clots, or vascular injury (~0.6%)
- The procedure is performed through a tiny incision of the skin with a catheter directed through the blood vessels.
- Like other vascular procedures, there is a small risk of bleeding, blood clots, injury to blood vessels, and hematoma at the access site (0.6%), although these are rare.
✔ Unintended Particle Migration: treatment involves the injection of small particles into the blood vessels of the knee. These vessels often have small branches that pass to other tissues and vessels (collaterals),
- Treatment particles could pass into other tissues such as:
- Nearby bone, muscle, ligaments, or skin.
- In most cases, this causes no symptoms.
- In some cases t may cause a mild discoloration of the skin around the knee that clears in a few days (12%).
✔ Possible minor rash, blisters, or small ulcers (~0.3%)
- May develop around the knee, but these typically heal within 1-2 weeks.
✔ Larger unintended embolization (exceedingly rare)
- If a larger number of particles travel to another tissue site, there can be more significant tissue injury.
- However, this is extremely rare because the treatment is performed under direct visualization using live x-ray (fluoroscopy) for precise guidance..
✔ Sedation risks: The procedure is performed under mild sedation rather than general anesthesia
- the associated risks of
allergic reactions, side effects, or other complications from sedation are low.
Do I qualify for the procedure?
If you have chronic knee pain lasting for more than 6 months and have tried conservative measures for pain control such as medications, joint injections, physical therapy, or other measures without satisfactory results, you are likely a candidate.
To qualify, you must have significant knee pain that is on average 5 or higher on a scale of 1 to 10. It must also affect your normal activities of daily living, such as climbing stairs, walking, standing, getting dressed, getting up from a chair, or other similar activities.
It also requires an imaging diagnosis on x-ray or MRI of osteoarthritis that correlate with the pain and show evidence of mild to moderate disease.
Most patients are also 45 years or older. In some cases of chronic, persistent pain after knee replacement surgery, you may qualify for treatment if other conservative measures have failed, and your surgeon does not recommend joint replacement or revision.
Patients may not qualify if they have advanced, severe osteoarthritis, where joint replacement is recommended.
It is also not recommended if you have a joint infection, any knee surgery in the past 6 months, inflammatory arthritis (i.e. Rheumatoid Arthritis), and in severe cases of vascular disease (peripheral arterial disease), severe cardiac disease, or other medical conditions that preclude performing the procedure safely.
Will my insurance cover the procedure?
Most standard, traditional insurances including Medicare cover the procedure if you meet medical requirements and necessity. We obtain pre-authorization from your insurance prior to performing the procedure. If you are out of network or do not have insurance, we can offer cash pay options, which would be discussed during the consultation.
What is recovery like?
- Patients generally go home the same day, shortly after the procedure.
- Patients can walk on their own, although we recommend limited activity for the first 24 hours and gradually return to activity over the next few days.
- Post-operative pain medications are provided, and we provide instructions to closely monitor the puncture/access site for bleeding or signs of infection.
- Some patients may also benefit from physical therapy to optimize joint health.
Is there good science behind this procedure?
The short answer is yes. The first treatment was performed in 2015 and has had numerous research
studies showing its effectiveness. However, it is still relatively new, and more research is being
performed and ongoing. Below are some studies if you are curious about the most recent scientific
research supporting this treatment:
1. Taslakian B, Miller L, Mabud T, et al. Genicular artery embolization for treatment of knee osteoarthritis
pain: Systematic review and meta-analysis. Osteoarthr Cartil Open. 2023 Feb 6;5(2):100342.
2. Tyagi R, Ahmed SS, Koethe Y, et al. Genicular artery embolization for primary knee osteoarthritis.
Semin Intervent Radiol. 2022 Jun 30;39(2):125-129.
3. Padia SA, Genshaft S, Blumstein G, et al. Genicular artery embolization for treatment of symptomatic
knee osteoarthritis. JB JS Open Access. 2021 Oct 21;6(4): e21.0085
4. Little MW, Gibson M, Briggs J, et al. Genicular artery embolization in patients with osteoarthritis of the
knee (GENESIS) using permanent microspheres: Interim Analysis. Cardiovasc Intervent Radiol. 2021
Jun;44(6):931-940.
5. Bagla S, Piechowiak 5. Bagla S, Piechowiak R, Hartman T, Orlando J, Del Gaizo D, Isaacson A.
Genicular artery embolization for the treatment of knee pain secondary to osteoarthritis. J Vasc Interv
Radiol. 2020;31(7):1096–1102
6. Okuno Y, Korchi AM, Shinjo T, Kato S, Kaneko T. Midterm clinical outcomes and MR imaging changes
after transcatheter arterial embolization as a treatment for mild to moderate radiographic knee
osteoarthritis resistant to conservative treatment. J Vasc Interv Radiol. 2017;28(7):995–1002.
7. 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.
