For chronic knee pain, genicular artery embolization provides a new alternative

by Kara Mason, CU Anschutz Medical Campus

edited by Lisa Lock, reviewed by Andrew Zinin

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The procedure was "remarkably" successful. That's how Cynthia Schraf-Fletcher, 74, describes her experience with genicular artery embolization (GAE), a minimally invasive procedure that treats chronic knee pain. Nearly a year after the outpatient surgery on her right knee, Schraf-Fletcher says the outcome is nearly identical to the total knee replacement she previously had on her left knee.

"I couldn't be more pleased," says Schraf-Fletcher, who turned to Leigh Casadaban, MD, MS, assistant professor of radiology at the University of Colorado Anschutz School of Medicine, for the procedure.

Now, gardening, exercising on a stationary bicycle and all Schraf-Fletcher's favorite activities come with far less pain and even more enjoyment, she says.

What is GAE?

Genicular artery embolization decreases blood flow to the inflamed areas of a joint, which can reduce swelling and pain.

"For treating osteoarthritis in the knees, we often think of medications, physical therapy, maybe a steroid injection, and then on the far end of the spectrum is a total knee replacement. There really hasn't been anything for patients in between," Casadaban, a vascular interventional radiologist, says. "GAE is a promising minimally invasive procedure that may fill that spot for people who have failed conservative treatments but are not yet ready to have a major surgery."

The best candidates for the procedure are people who have mild to moderate osteoarthritis, Casadaban says. While those with more severe cases can have the procedure done, results don't tend to be as long-lasting.

"We find about 70% of patients have phenomenal results. They cut their pain scores in half, sometimes more. We have a few patients with no pain at all after the procedure," Casadaban says. "Patients who have tried a lot of other treatments and haven't had pain relief are happy to get back to their normal activities."

After having complications with the knee replacement surgery, Schraf-Fletcher says she was all in on giving GAE a try, and she's glad she did.

The procedure itself can take one to two hours under conscious sedation. An interventional radiology team makes a small incision in the crease of the leg and then threads a tiny catheter through the femoral artery with guidance from X-ray imaging and contrast. When the team reaches the genicular arteries, it releases tiny beads that block blood flow to the abnormal vessels in the specific areas the patient identifies.

Clinicians observe patients for a few hours after the procedure, and then patients go home the same day with instructions to take it easy for a few days.

The GAE procedure originated in Japan just over a decade ago and has grown considerably across the globe. The FDA has granted "breakthrough device status" for many devices in the U.S. since 2021.

Ongoing research

Data on the procedure is promising so far.

"The theory is that GAE reduces inflammation inside the knee joint, and symptom relief can last years," Casadaban says. "Four-year data published in Japan shows that if you have one outpatient procedure, your pain relief can last for those four years. In the U.S., we now have two-year data, which shows that if you have a good response, pain relief can last two years. That really speaks to the theory that we're hopefully modifying something in the joint."

Casadaban is also leading clinical trials at CU Anschutz, one specifically looking at changes in fluid in the knee in patients undergoing GAE, and the other is studying a new temporary treatment device in the arteries called Nexsphere-F that blocks small blood vessels in the knee that may be related to inflammation and pain.

Osteoarthritis, a degenerative joint disease, affects millions of people each year and can affect joints of all kinds. While GAE is only being used in knees right now, Casadaban says the procedure is expanding to other joint treatments, like frozen shoulder, tennis elbow and plantar fasciitis.

Key medical concepts

Osteoarthritis, KneeKnee Replacement

Clinical categories

OrthopedicsDiagnostic radiologyCommon illnesses & Prevention Provided by CU Anschutz Medical Campus Who's behind this story?

Lisa Lock

BA art history, MA material culture. Former museum editor, paramedic, and transplant coordinator. Editing for Science X since 2021. Full profile →

Andrew Zinin

Master's in physics with research experience. Long-time science news enthusiast. Plays key role in Science X's editorial success. Full profile →

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