Overview
Knee osteoarthritis can make simple activities such as walking or climbing stairs incredibly painful. As the cartilage inside the knee wears down, the lining of the joint becomes chronically inflamed. That inflammation triggers the growth of abnormal new blood vessels, and those vessels bring sensitive nerve endings with them, creating a constant cycle of pain and swelling.
Genicular artery embolization (GAE) is a minimally invasive procedure that breaks this cycle by safely blocking the abnormal blood vessels.
It is a modern option for patients who are not ready for a total knee replacement but are no longer getting relief from conservative treatment.
Embolization stops the inflammation at its source, significantly reducing knee pain and stiffness without major orthopedic surgery or a gruelling rehabilitation.
Who it’s for
Most patients considering this procedure come to the clinic with chronic knee pain from osteoarthritis. They have typically tried physical therapy, daily anti-inflammatory medication, and cortisone or gel injections without lasting relief, and the pain is actively interfering with their quality of life, sleep, and daily activities.
We review your medical history and imaging, such as X-rays or an MRI, to confirm the severity of the arthritis and to make sure you are a good candidate for the procedure.
Who is not a candidate
If your knee pain is caused by an acute meniscus or ligament tear, or by an active joint infection, embolization is not the right treatment. In those cases we will direct you to the appropriate orthopedic specialist for your care.
How the procedure works
1. Accessing the artery
An interventional radiologist cleans and numbs a small area at the top of the thigh or at the foot. A tiny tube called a catheter, about the width of a piece of spaghetti, is inserted through a small needle puncture access into the artery.
2. Navigation and imaging
Using real-time X-ray guidance (fluoroscopy), the catheter is navigated through your blood vessels directly to the genicular arteries, which supply the knee joint. You will not feel this happening inside your body.
3. Embolization: blocking the vessels
Once the catheter is precisely positioned near the abnormal vessels feeding the inflammation, either crystallised antibiotic particles or tiny gel particles are injected. They wedge into the inflammatory vessels and safely block their blood flow, while leaving the healthy vessels intact.
4. Relief and restoration
Deprived of their abnormal blood supply, the inflamed tissue in the knee lining shrinks and the extra nerve endings recede. The catheter is removed and a simple bandage is applied.
What to expect on the day
When you arrive, our team will get you comfortable and start an IV. This is not a painful procedure, and it can be performed awake with local numbing alone. We may also provide “twilight” sedation if desired, in which case you will be relaxed and sleepy but breathing on your own, without a breathing tube or general anesthesia.
The procedure itself typically takes about 45 minutes. Because there are no surgical incisions, you go home the same day.
You will rest in our recovery room for about an hour afterward.
Recovery
Recovery is highly manageable. On day one, plan to rest at home. You may have mild soreness at the access site, and your knee may feel slightly achy or stiff. This is completely normal and is easily managed with over-the-counter pain relievers such as ibuprofen or acetaminophen.
By the end of the first week most patients feel back to their baseline. You can typically return to a desk job or normal daily activities within two to three days. We ask that you avoid heavy lifting and strenuous leg exercise for about a week so the access site heals properly.
What is normal, and when to call
Mild bruising at the entry site is completely normal. Call our office if you experience severe or worsening pain, a fever above 101°F, active bleeding at the access site, or any sign of infection.
Risks and considerations
Genicular artery embolization is highly safe, but as with any procedure there are potential risks, and we would rather set them out plainly.
Common, minor side effects include bruising at the access site and a temporary change in skin colour over the knee. This looks like a mild rash or a mottled patch and resolves completely on its own within a few days.
Rare but more serious risks include infection, injury to the blood vessel, and non-target embolization, where the particles block blood flow to healthy tissue. Because the procedure is performed by a highly trained interventional radiologist using advanced, real-time imaging, the risk of major complications is extremely low.
Results and evidence
Dr. Golowa was among the first physicians in New York City to perform genicular artery embolization for knee pain.
The clinical evidence supporting GAE for knee osteoarthritis is growing rapidly. Studies show a technical success rate of nearly 100%, meaning the target arteries can almost always be reached and treated successfully.
For symptom relief, roughly 70% to 80% of patients experience a significant and rapid decrease in knee pain, particularly weight-bearing pain and night-time pain. Patients also report major improvements in stiffness and function.
Clinical studies show that this relief is durable, allowing patients to stay active and to delay the need for a knee replacement for years.
Common questions
- Is it painful?
- The procedure is well tolerated. We numb the entry site with local anesthesia and may provide IV sedation if desired, and you will not feel the catheter inside your body. Afterward your knee may ache mildly for a few days, which is easily managed with over-the-counter pain medicine.
- Will insurance cover it?
- Coverage can vary, because GAE is a newer application of embolization. It is increasingly covered by major carriers once standard treatments such as injections and physical therapy have failed, though some currently consider it investigational. Our office will work closely with your insurance provider to verify your exact benefits and out-of-pocket costs before you proceed.
- How soon will I notice a difference?
- Many patients notice a significant reduction in knee pain within the first two weeks. As the inflammation settles you will find it much easier to walk, climb stairs, and get through daily activities, with continued improvement in mobility over the next one to three months.
- What happens if it doesn’t work?
- If you do not have adequate relief after a few months, we will re-evaluate your knee. And if embolization ultimately does not relieve your symptoms, it does not compromise future treatment: you remain a full candidate for traditional orthopedic care, including a total knee replacement.
