Does Genicular Artery Embolization (GAE) work for knee osteoarthritis or is it a hoax?

Genicular artery embolization or GAE, is not a hoax but a legitimate and promising minimally invasive procedure for treating knee pain associated with osteoarthritis (OA). Multiple studies from reputable instutions have demonstrated its effectiveness and safety, although more research is still ongoing to fully establish its long-term benefits.

Evidence Supporting GAE

Clinical Trials and Studies

Several clinical trials and studies have shown positive results for GAE:

- A randomized controlled trial in 2022 compared GAE to a sham procedure. At 12 months, patients receiving GAE exhibited statistically significant reduction in pain scores.

- A prospective, single-center pilot study involving 12 patients with persistent pain after total knee arthroplasty (TKA) showed improvement in pain scores post-GAE.

- The GAUCHO trial, a single-center, prospective, randomized controlled trial, reported a 1-year cumulative clinical success rate of ≥60% as measured by WOMAC and KOOS scores.

Mechanism of Action of GAE

GAE works by targeting the abnormal blood vessels (angiogenesis) associated with knee OA. The procedure involves decreasing these abnormal blood vessels, which is thought to reduce pain by decreasing synovial inflammation and nerve ingrowth.

Effectiveness and Safety

Pain Reduction

Multiple studies have reported significant pain reduction following GAE:

- Patients were followed up to 2 years in one  study with substantial  improvement pain and function compared to baseline.

- GAE has shown to be effective in reducing pain, particularly in patients with mild to moderate OA (Kellgren-Lawrence grade 1 and 2).

Safety Profile

GAE has proven to be a safe procedure with only mild complications reported. Some potential side effects include:

- Self-limited skin discoloration
- Temporary increase in pain immediately after the procedure
- Rare cases of nerve injury, bone infarction, or non-target embolization[6]

Ongoing Research

While the initial results are promising, researchers continue to investigate GAE:

- A large-scale trial involving up to 110 participants is currently underway to further evaluate the use of a permanent embolic agent for GAE.

- Studies are exploring preprocedure MRI findings to better predict patient outcomes and improve patient selection for the procedure.

Conclusion

Genicular artery embolization is not a hoax but a legitimate medical procedure supported by growing clinical evidence. It offers a minimally invasive option for patients with knee OA who have not responded well to conservative treatments. While the results are promising, it's important to note that more research is needed to fully establish its long-term efficacy and identify the most suitable candidates for the procedure.

Experience is Key – GAE is a procedure that requires technical skills and knowledge. You want to find an Interventional Radiologist who has substantial experience with embolization techniques.