Knee Osteoarthritis Pain Relief Options: From Basic Care to GAE

If knee osteoarthritis pain is getting in the way of your day, it helps to know what options exist. The range starts with conservative care, such as exercise-based physical therapy, weight management if needed, and medications or injections when appropriate. For some people whose pain continues, it can also include minimally invasive procedures such as genicular artery embolization (GAE), and in some situations, knee replacement.

Knee osteoarthritis is the most common “wear and tear” arthritis. Over time, the cartilage that cushions your knee can thin out, and the joint can get irritated and inflamed. That irritation can lead to chronic knee pain, stiffness, swelling, and popping or grinding sounds.

Below, we walk through the treatment options, explain where GAE fits, and share what the research says about how well it works, including the parts that are still uncertain. No single option is right for everyone, and a qualified clinician can help you sort through them.

What is conservative care for knee osteoarthritis pain?

Conservative care usually means the basics that are boring but effective. These include:

• Exercise-based physical therapy
• Weight management, if needed
• Medications or injections, when appropriate

This approach is discussed in published osteoarthritis guidelines (8, 9). Your clinician can help you decide which of these basics make sense for you, and how to combine them.

What other treatment options may come up?

If the basics have not helped enough, a conversation about options may include nonsurgical care, injections, nerve-based treatments, and when knee replacement may be more appropriate (8, 9). Minimally invasive procedures such as GAE are another option that some people explore.

Some people want to avoid or delay knee replacement if possible, and that goal can shape the conversation. The right choice depends on your symptoms, your history, and your imaging. A clinician can help you understand whether GAE makes sense in your situation, or whether another approach is more likely to help.

Where does GAE fit in?

GAE is a minimally invasive procedure that targets tiny blood vessels around the knee called the genicular arteries. In many people with osteoarthritis, parts of the knee lining, called the synovium, can become inflamed and develop extra small blood vessels. Those vessels can help “feed” ongoing inflammation and pain.

“Embolization” simply means blocking some of those extra tiny vessels using very small particles. The goal is to calm down inflammation and reduce pain over time. Think of it as turning down the volume on an overactive irritation signal rather than replacing the joint.

GAE is designed to reduce pain and inflammation, not rebuild cartilage, so keep your expectations realistic. VidaVascular offers GAE as a minimally invasive option for certain people with knee osteoarthritis pain who want to explore nonsurgical relief.

How well does GAE work for knee osteoarthritis pain?

Here is the straight talk: GAE has promising evidence, but it is still evolving. Early prospective studies and some trials show meaningful improvements in pain and function for many patients (1, 2, 4, 5, 7). At the same time, results can vary, and some sham-controlled trials show a strong placebo effect (1, 2, 3, 4, 5). A sham procedure is a pretend version of the treatment, used so researchers can compare.

Here is what research shows so far:

• A sham-controlled randomized study reported greater pain and disability improvement at 1 month in the treated group (1).
• A triple-blind randomized trial in early-stage osteoarthritis evaluated GAE versus a sham procedure (2).
• Another double-blind sham-controlled trial found similar pain reduction in both the GAE and sham groups at 4 months, suggesting that placebo and patient selection matter a lot (3).
• Longer follow-up studies show that some patients maintain improvement at 2 years, especially if they respond well earlier on, but not everyone does (6, 7).

The bottom line: many people improve, some do not, and researchers are actively working on better ways to predict who benefits most. A good evaluation is what keeps this from turning into a coin flip.

What risks should you know about?

GAE is minimally invasive, but it is not “no big deal.” It still involves working inside blood vessels, so safety planning matters. Possible side effects and risks reported in studies include:

• Temporary skin discoloration or bruising near the knee, which often resolves (7)
• Groin bruising or a hematoma at the access site (7)
• Temporary increased soreness or inflammation as the knee settles
• Rare complications such as blood clots, reported in longer-term studies (7)

Some trials reported no serious adverse events, while noting more mild side effects in the treated group than in sham groups (3).

When to call right away: If you ever develop severe worsening pain, high fever, chest pain, shortness of breath, or sudden leg swelling after any procedure, that is “call now,” not “wait and see.”

When should you see a vascular specialist?

GAE is generally discussed for people with symptomatic knee osteoarthritis who still hurt despite conservative care. A provider may consider genicular artery embolization if you have:

• Chronic knee pain from osteoarthritis that limits daily activities
• Symptoms that did not improve enough with conservative treatments
• A desire to avoid or delay knee replacement, if possible
• Imaging that supports osteoarthritis as a main pain source

GAE may not be a good fit, or may need extra caution, if you have an active infection, poor circulation, or certain bleeding risks. It may also not fit if your knee pain is mainly caused by a different problem, such as a fracture, a major ligament injury, or another inflammatory arthritis.

A first visit usually starts with a focused evaluation. It can include a detailed symptom review and a look at imaging, often X-ray and sometimes MRI depending on your situation. At VidaVascular, Dr. Meghal Antani, Medical Director and a board certified vascular and interventional radiologist, and the team can review your symptoms and history and help you understand your options. You can also browse other issues we treat on our conditions page.

Ready to talk it through? Call VidaVascular at (866) 800-2346 or request an appointment. You can visit us at our offices in Oxon Hill and White Plains, MD and Springfield, VA (see our locations).

References

1. Bagla, S., Piechowiak, R., Sajan, A., Orlando, J., Hartman, T., & Isaacson, A. (2022). Multicenter randomized sham controlled study of genicular artery embolization for knee pain secondary to osteoarthritis. Journal of Vascular and Interventional Radiology, 33(1), 2-10.e12. https://doi.org/10.1016/j.jvir.2021.09.019
2. Landers, S., Hely, R., Hely, A., Harrison, B., Page, R. S., Maister, N., Gwini, S. M., & Gill, S. D. (2023). Genicular artery embolization for early-stage knee osteoarthritis: Results from a triple-blind single-centre randomized controlled trial. Bone & Joint Open, 4(3), 158-167. https://doi.org/10.1302/2633-1462.43.BJO-2022-0161.R2
3. van Zadelhoff, T. A., et al. (2024). Genicular artery embolisation versus sham embolisation for symptomatic osteoarthritis of the knee: A randomised controlled trial. BMJ Open. https://doi.org/10.1136/bmjopen-2024-087047
4. Okuno, Y., Korchi, A. M., Shinjo, T., & Kato, S. (2017). 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. Journal of Vascular and Interventional Radiology, 28(7), 995-1002.
5. Taslakian, B., Miller, L. E., Mabud, T. S., Macaulay, W., Samuels, J., Attur, M., Alaia, E. F., Kijowski, R., Hickey, R., & Sista, A. K. (2023). Genicular artery embolization for treatment of knee osteoarthritis pain: Systematic review and meta-analysis. Osteoarthritis and Cartilage Open, 5(2), 100342. https://doi.org/10.1016/j.ocarto.2023.100342
6. Cusumano, L. R., Sparks, H. D., Masterson, K. E., Genshaft, S. J., Plotnik, A. N., & Padia, S. A. (2024). Genicular artery embolization for treatment of symptomatic knee osteoarthritis: 2-year outcomes from a prospective IDE trial. Journal of Vascular and Interventional Radiology. https://doi.org/10.1016/j.jvir.2024.08.028
7. Little, M. W., O’Grady, A., Briggs, J., Gibson, M., Speirs, A., Al-Rekabi, A., Yoong, P., Ariyanayagam, T., Davies, N., Tayton, E., Tavares, S., MacGill, S., McLaren, C., & Harrison, R. (2024). Genicular artery embolisation in patients with osteoarthritis of the knee (GENESIS) using permanent microspheres: Long-term results. Cardiovascular and Interventional Radiology, 47(12), 1750-1762. https://doi.org/10.1007/s00270-024-03752-7
8. Bannuru, R. R., Osani, M. C., Vaysbrot, E. E., Arden, N. K., Bennell, K., Bierma-Zeinstra, S. M. A., Kraus, V. B., Lohmander, L. S., Abbott, J. H., Bhandari, M., et al. (2019). OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and Cartilage, 27(11), 1578-1589.
9. Kolasinski, S. L., Neogi, T., Hochberg, M. C., Oatis, C., Guyatt, G., Block, J., Callahan, L., Copenhaver, C., Dodge, C., Felson, D., et al. (2020). 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis & Rheumatology, 72(2), 220-233.