Genicular artery embolization, often called GAE, may be an option for some people with knee osteoarthritis pain who still hurt despite conservative care. It is not for everyone. Whether it fits depends on your symptoms, your history, and what your imaging shows.
You may also see this procedure written as “geniculate artery embolization.” In the medical source we rely on, the name is genicular artery embolization, so that is the name we use here.
This guide explains who may be a good candidate, who may need extra caution, and what an evaluation involves. Our source does not set an age range for GAE, so we focus on the factors it does describe. The only way to know whether GAE fits you is an evaluation with a qualified clinician.
What is genicular artery embolization?
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 inflammation and reduce pain over time. It is aimed at pain and inflammation, not at replacing the joint.
Who might be a good candidate, and who may need extra caution?
Who might be a good candidate?
GAE is generally discussed for people with symptomatic knee osteoarthritis who still hurt despite conservative care. Conservative care usually means exercise-based physical therapy, weight management if needed, and medications or injections when appropriate.
Your provider may consider GAE 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
Taken together, these points describe someone whose pain is real and affects daily life, whose osteoarthritis appears to be the main source of that pain, and who has already given the basics a fair try.
Who may need extra caution or a different approach?
GAE might not be the best fit, or may need extra caution, if you have:
- Active infection, poor circulation, or certain bleeding risks
- Knee pain mainly caused by a different problem, such as a fracture, a major ligament injury, or another inflammatory arthritis
- Expectations that it will “cure” arthritis
That last point deserves a closer look. GAE is designed to reduce pain and inflammation, not rebuild cartilage. If you are hoping for a cure, it helps to talk that through before deciding.
Notice the careful wording: “might not be the best fit” and “may need extra caution.” That is a reason to talk with your clinician, not a reason to rule yourself in or out on your own.
What does the evaluation involve?
The first step is usually a focused evaluation to confirm that osteoarthritis is the main driver of your pain and that you are a reasonable candidate. In many practices, that evaluation may include three parts.
- A detailed symptom review. Where it hurts, what triggers it, and what you have tried.
- A review of imaging. Often an X-ray, and sometimes an MRI, depending on your situation.
- A discussion of options. This can include nonsurgical care, injections, nerve-based treatments, and when knee replacement may be more appropriate.
The goal is clarity, not hype. If GAE is a fit, you should understand what success looks like, what timelines are realistic, and what the alternatives are. If another approach is more likely to help, that is a good outcome too.
What should you know about results and risks before deciding?
GAE has promising evidence, but that evidence is still evolving. Studies have shown improvements in pain and function in many patients, although results can vary. Some sham-controlled trials show a strong placebo effect, and one double-blind sham-controlled trial found similar pain reduction in the GAE and sham groups at 4 months. That suggests placebo and patient selection matter a lot.
Some patients keep their improvement at 2 years in longer follow-up studies, especially if they respond well early on, but not everyone does. Many people improve and some do not, and researchers are still working on better ways to predict who benefits most. A careful evaluation helps keep this from being a coin flip.
GAE is minimally invasive, but it is not “no big deal,” because it involves working inside blood vessels. Possible side effects reported in studies include temporary skin discoloration or bruising near the knee, groin bruising or a hematoma at the access site, and temporary soreness or inflammation as the knee settles.
Rare complications such as blood clots have been reported in longer-term studies. Some trials reported no serious adverse events, while noting more mild side effects in the treated group than in sham groups.
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?
Consider an evaluation if your osteoarthritis pain limits your daily activities and has not improved enough with conservative care. At VidaVascular, the team can review your symptoms and history and help you understand whether genicular artery embolization makes sense in your situation, or whether another approach is more likely to help.
You can also browse the conditions VidaVascular evaluates and treats to learn more about our care.
Ready to talk it through? Call VidaVascular at (866) 800-2346 or request an appointment. We see patients at our offices in Oxon Hill and White Plains, MD and Springfield, VA. You can find all of our locations here.
References
- 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
- 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
- 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
- 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.
- 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
- 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
- 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
- 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.
- 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.
