Interventional Radiology in Focus: Current Perspectives on Genicular Artery Embolization for Knee OA

For patients with knee osteoarthritis, the primary treatment is usually conservative management with over the counter (OTC) medications and subsequent knee injections. All these efforts may provide pain relief that lasts a few months and eventually it gets to the point where they might need knee replacement surgery. Unfortunately, between those conservative measures, injections, OTC meds, and even some things like genicular nerve ablation and surgery, there is a big gap.

Genicular artery embolization (GAE) is a newer procedure that fills that gap by either delaying surgery or giving patients options who don't want to have surgery or are not candidates for surgery. Genicular artery embolization really has made a significant impact in treating knee arthritis pain and improving quality of life.

Traditionally, the thought process was that osteoarthritis in the knee is primarily a wear and tear issue. The most recent understanding is that there's an inflammatory component and cytokines that cause inflammation, and there's new angiogenesis and sensory nerves that cause pain, synovitis and the inflammation. It's a cycle.

The nice thing about GAE is that compared to traditional knee pain interventions, the results can last. In some patients, the pain relief may last up to two years. This is unheard of in comparison to injections or nerve ablation, with pain relief lasting a few months. Performing GAE is a great opportunity for interventional radiologists to really showcase what we can do to have a big impact in the patient's quality of life.

In terms of evidence for this procedure, it started in the early 2000s with case reports on its utility for knee arthrosis and the setting of post-knee replacement surgery. Since then, more studies have come out with high-level evidence showing the impact in arthritis. Multiple studies, including randomized control studies, have shown significant improvement with GAE.

Genicular artery embolization (GAE) is one of those procedures that really reflects the enthusiasm and innovation of interventional radiologists. This procedure has a significant impact, but it's not always known, and we have to do better to advocate for our patients. We have to raise awareness. Interventional radiology is a very rapidly evolving specialty with technology and far-reaching implications. Oftentimes, the rest of medicine might take a while to catch up.

(Editor’s note: For related content, see “Emerging Topics in Interventional Radiology: The Role of Geniculate Artery Embolization to Treat Knee Osteoarthritis,” “New Interventional Radiology Research Shows Merits of Genicular Artery Embolization for Knee OA” and “New MRI Study Questions Use of Corticosteroid Injections for Knee OA.”)

Dr. Makary is a vascular and interventional radiologist. He is an associate professor of radiology at the Ohio State University Wexner Medical Center.

References

1. Bagla S, Piechowiak R, Sajan A, Orlando J, Hartman T, Isaacson A. Multicenter randomized sham controlled study of genicular artery embolization for knee pain secondary to osteoarthritis. J Vasc Interv Radiol. 2022;33(1):2-10.e2.

2. 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.

3. Mora JC, Przkora R, Cruz-Almeida Y. Knee osteoarthritis: pathophysiology and current treatment modalities. J Pain Res. 2018;11:2189-2196. Published 2018 Oct 5. doi:10.2147/JPR.S154002.

4. Taslakian B, Miller LE, Mabud TS, et al. Genicular artery embolization for treatment of knee osteoarthritis pain: systematic review and meta-analysis. Osteoarthr Cartil Open. 2023;5(2):100342. doi:10.1016/j.ocarto.2023.100342.

(Editor’s note: The images in the video are courtesy of Adobe Stock and the Journal of Vascular and Interventional Radiology.)