Genicular Artery Embolization (GAE)

Genicular Artery Embolization for knee Osteoarthritis

Genicular artery embolization (GAE), or embolization of the knee, is a novel minimally-invasive procedure providing immediate and long term pain relief for patients with osteoarthritis (OA), by reducing the blood flow to the lining of the knee, known as the synovium. It is performed by an Interventional Radiologist (IR), who is a specialist physician that uses X-rays and other imaging modalities to see in the body and treat diseases without surgery.

Treatment for: Osteoarthritis of the knee

Why it’s done:

GAE blocks the blood flow to the lining of the knee, known as synovium, that are inflamed. By blocking these arteries, there is a reduction in the amount of inflammation associated with osteoarthritis, a process that can help or eliminate the associated knee pain. While further research is needed, initial trials shows the promise this technique holds for patients with debilitating knee pain who are not ready or willing to undergo knee replacement surgery. While it may not treat the underlying cartilage destruction, evidence so far shows that this may be an effective way to manage the symptoms. In an article published in the Society of Interventional Radiology in March 2021, average pain scores decreased from eight out of ten before GAE to three out of ten within the first week.

How is GAE performed:

GAE is performed with moderate ‘twilight’ sedation as an outpatient procedure, meaning the patient will go home after the procedure. The procedure generally takes one to two hours. Our IR physicians will insert a small catheter (a thin hollow tube) into the artery of the patient’s upper thigh and, with the use of X-rays, guide the catheter to the arteries supplying the lining of the knee. Tiny particles are then injected through the catheter into these arteries, reducing the blood supply. This in turn reduces the inflammation associated with osteoarthritis, which alleviates the pain.

knee before & after embolization

Initial (left) and final (right) angiograms of the knee after embolization. A circular marker was placed at the site of pain. The reduced blood-flow at the site of pain after embolization reduced inflammation of the knees.

What happens after the GAE procedure:

Patients go home the same and in most cases, relief begins to occur in two weeks, as the inflammation in the lining of the knee is reduced, relieving the knee pain associated with osteoarthritis.

Are you a candidate for GAE:

GAE is a non-surgical treatment alternative for patients with knee pain due to osteoarthritis who have failed conservative therapy, such as anti- inflammatory medications or knee injections, and who do not wish to undergo or are ineligible for knee replacement surgery.

The following conditions make for a good candidate for GAE:

  • Age: 40-80 years
  • Moderate to severe knee pain
  • Osteoarthritis based on x-ray, but without bony deformity/sclerosis
  • Local knee tenderness
  • Resistant/failed conservative treatment (NSAIDS/PT/joint injection)

The following conditions may disqualify a patient as a candidate for GAE:

  • Current or previous history of cigarette smoking
  • Advanced arthritis based on x-ray
  • Infection or malignancy
  • Good candidate for knee replacement surgery