Genicular Artery Embolization: A Minimally Invasive Approach to Knee Osteoarthritis
Summary
- More than one in three Americans older than 60 have radiographic evidence of knee osteoarthritis. Approximately 40% report bothersome symptoms.
- UHealth interventional radiologists have adopted genicular artery embolization as a minimally-invasive treatment option for patients with symptomatic knee osteoarthritis.
- GAE is suitable for a broad patient population, including people from 40 to 80 years old, athletes and individuals with persistent pain after knee replacement.
Knee osteoarthritis is a degenerative joint disease that affects millions worldwide and is the leading cause of disability in older adults. In the United States alone, more than one in three people older than 60 have radiographic evidence of knee osteoarthritis. Approximately 40% report bothersome symptoms.
Knee osteoarthritis is characterized by progressive cartilage wear, bony remodeling and chronic inflammation, resulting in pain, stiffness and reduced mobility. While conservative treatments such as physical therapy, medications and injections are widely used, many patients find these measures insufficient for long-term relief. Total knee arthroplasty remains the standard for severe knee osteoarthritis, but only 9% to 33% of eligible patients are willing to consider surgery, and up to 20% report persistent pain.
“Chronic knee pain from osteoarthritis often leads to a gradual loss of autonomy, limiting participation in work, exercise and social activities,” said Victor Hugo Hernandez, M.D., professor and chief in the Division of Arthroplasty and Adult Joint Reconstruction at the University of Miami Miller School of Medicine. “This loss of function and confidence is frequently as debilitating to patients as the pain itself.”
UHealth’s Interventional Radiology Approach
Recognizing the need for innovative, less-invasive solutions, UHealth—University of Miami Health System interventional radiologists have adopted genicular artery embolization (GAE) as a novel, minimally-invasive treatment option for patients with symptomatic knee osteoarthritis who are reluctant or ineligible for surgery. GAE is a minimally invasive, outpatient procedure performed by interventional radiologists using advanced imaging guidance.
“By precision-targeting the abnormal blood vessels involved in knee osteoarthritis, GAE provides a novel alternative that calms overactive blood flow to restore joint comfort and mobility through a simple, same-day outpatient procedure,” said Bedros Taslakian, M.D., associate professor of clinical interventional radiology and vice chair of research in the Department of Interventional Radiology at the Miller School.
The technique involves selective catheterization of the genicular arteries and targeted blocking of abnormal neovasculature associated with pain and inflammation. GAE works by reducing synovial blood flow, which decreases knee pain related to inflammation, neovascularity and abnormal nerve growth. During the procedure, a tiny catheter is inserted into the femoral artery and guided to the genicular arteries. Embolic agents are injected to block abnormal blood vessels, effectively “quieting” the inflammation and disrupting the cycle of pain.
The procedure typically lasts about two to three hours, is performed under local anesthesia and moderate sedation, and allows patients to return home the same day.
Advantages of GAE Over Traditional Treatments
GAE offers several advantages:
• Minimally invasive: No large incisions, stitches or overnight hospital stays. Most patients resume normal activities within days.
• Rapid pain relief: Clinical studies show average pain scores drop 40% to 50% within the first week, with sustained improvements for one to three years.
• Low risk profile: Adverse events are rare and typically minor, such as transient skin discoloration (11.6%) and mild knee pain (1.2%).
• Delay or avoid surgery: GAE is ideal for patients not ready for knee replacement or those with medical contraindications to surgery.
• Improved mobility and quality of life: Many patients report significant improvements in mobility and reduced reliance on pain medications.
“GAE demonstrates a high level of procedural reliability and sustained efficacy, with an immediate technical success rate ranging from 95% to 100%,” Dr. Taslakian said. “Clinical success, often defined as a 50% or more reduction in pain scores, is achieved in 65% to 85% of patients. Long-term data show that the average pain drop is substantial and durable.”
UHealth’s Research Leadership
UHealth’s adoption of GAE is underpinned by pioneering research led by Dr. Taslakian. His meta-analysis, published in Osteoarthritis and Cartilage Open, evaluated the safety and effectiveness of GAE across nine studies involving 270 patients and 339 knees. The findings are compelling:
• Technical success: 99.7% of procedures were completed successfully.
• Pain reduction: Over 12 months, patients experienced a weighted mean reduction of 34 to 39 points on the pain scale and 28 to 34 points on the WOMAC Total Score, a measure of pain and function.
• Clinical benefit: At 12 months, 78% met the minimal clinically important difference for pain and 92% for function.
• Durability: Only 5.2% needed knee replacement and 8.3% repeat GAE over two years.
• Safety: Adverse events were minor and transient.
Dr. Taslakian’s research also found that patients with greater baseline pain severity were more responsive to GAE, suggesting the procedure may be particularly beneficial for those with moderate to severe symptoms.
In a study published in the Journal of Vascular and Interventional Radiology earlier this year, Dr. Taslakian, the principal investigator, showed that 60% of clinical trial participants experienced significant pain relief and GAE may provide long-term improvement.
“Our study findings also indicate that genicular artery embolization may, if further larger clinical trials prove successful, slow down the progression of osteoarthritis by observing significant decreases in signaling proteins, specifically vascular endothelial growth factor and interleukin 1 receptor agonist, one year after the procedure,” Dr. Taslakian said.
Patient Experience and Future Directions
Knee osteoarthritis care at UHealth involves a multidisciplinary team approach, allowing physicians to select the best possible treatment for patients. As a procedure, GAE is suitable for a broad patient population, including people from 40 to 80 years old, athletes and individuals with persistent pain after knee replacement. UHealth continues to participate in clinical trials and research collaborations to further refine patient selection and optimize outcomes.
“Knee osteoarthritis imposes a substantial quality-of-life burden, particularly for patients who experience persistent pain despite conservative therapy but are not yet candidates for joint replacement,” said Dr. Hernandez. “These patients often seek minimally invasive solutions that can restore function and reduce pain without major surgery.”
Genicular artery embolization represents a significant advance in the management of knee osteoarthritis, offering safe, effective and durable pain relief for patients who seek alternatives to surgery.
Tags: Department of Interventional Radiology, Department of Orthopaedics, Dr. Bedros Taslakian, Dr. Victor H. Hernandez, genicular artery embolization (GAE), interventional radiology, knee injuries