Individuals with knee osteoarthritis can find themselves in a difficult cycle. Physical therapy may help for a while, along with injections, but the pain keeps coming back or getting worse. Many of these patients are not good candidates for knee replacement surgery or would like to try to put it off as long as possible. At Orange County Interventional Radiology, we offer minimally invasive options that bridge the gap between these solutions. One of the treatments we offer in Lake Forest, Mission Viejo and Irvine is genicular artery embolization (GAE). 

The Treatment Gap Between Injections and Knee Replacement

The first treatment steps in knee osteoarthritis are typically conservative. Patients may try weight management, physical therapy and over-the-counter pain medication, followed by cortisone or hyaluronic acid injections. While these methods can benefit some, they often do not treat the cause of the problem, and some can cause unwanted side effects, like reduced knee cartilage. When these methods stop working, the next recommendation is often a total knee replacement. However, many patients are too young for a replacement or have health conditions that make surgery risky. Others simply want to keep their natural joint for as long as possible. GAE was developed for this group. 

What Is Genicular Artery Embolization?

GAE is a minimally invasive treatment that blocks the blood vessels that feed the inflammation inside an arthritic joint. During this surgery, a thin catheter is placed through a tiny puncture in the upper thigh and releases tiny particles into the arteries. Blood flow to the inflamed tissue drops, which leads to reduced pain and inflammation. The rest of the knee and leg continue to receive normal blood flow. Patients are able to go home the same day as the treatment, and there are no incisions to heal from.

Why Does Knee Pain Get Worse? 

As cartilage breaks down, the lining of the knee joint becomes inflamed, which triggers the growth of new, abnormal blood vessels in the joint lining. This is called neovascularization, and, in the case of knee osteoarthritis, the new vessels also bring more inflammatory cells into the knee and carry tiny nerve fibers with them. This amplified pain signaling is one reason that chronic knee pain tends to intensify even when the cartilage damage looks stable.

How Genicular Artery Embolization Interrupts the Pain Cycle    

Healthy knees do not have the same extra blood vessels as arthritic knees. A study on GAE published in the Journal of Vascular and Interventional Radiology found that reducing this blood flow provided relief at 24 months for 72% of participants who received initial benefits. 

GAE also treats the inflammation around the joint without impacting the bone or cartilage. If a knee replacement becomes necessary years later, GAE will not interfere with it. It can provide improvements while still keeping the door open to surgical intervention later when needed.  

Who Is a Good Candidate for GAE

You may be a good candidate for this treatment if:

• You Have Tried Conservative Care Without Relief: Patients who have used physical therapy, anti-inflammatory medication or injections and still have daily pain are often good candidates.
• You Are Not Ready for Knee Replacement: Younger patients who want to preserve their natural knee often choose GAE as a bridge.
• You Are Not a Surgical Candidate: Patients with heart disease, diabetes or weight concerns that raise surgical risk can often still receive GAE safely.
• You Want Minimal Downtime: Most patients return to desk work within one to two days of treatment.
• You Still Have Pain After a Knee Replacement: Persistent inflammation around an artificial joint can be treated with GAE without affecting the implant.
• You Have Mild to Moderate Symptoms: We have found that this treatment can provide relief to about ⅔ of our patients who have mild to moderate discomfort that affects their daily lives. 

What the Research Shows About GAE

A systematic review and meta-analysis in Osteoarthritis and Cartilage Open pooled data from multiple GAE studies, with results that were encouraging. These studies found that there were significant reductions in knee pain and WOMAC scores sustained well beyond the first year after the treatment. We have noticed similar results from our own patient population. For the patients for whom this treatment works, they start to see improvement within four to six weeks and make further gains over the following months. Larger randomized trials are still ongoing as we learn more about this treatment.

How GAE Compares to Other Knee Pain Treatments

GAE vs. Cortisone and Hyaluronic Acid Injections

Injections calm inflammation temporarily. Relief usually lasts three to six months and may become less effective with time. Cortisone is not a good option for frequent or long-term use because of the potential for cartilage loss. GAE addresses the source of ongoing inflammation and can last past the window of a typical injection cycle.

GAE vs. Knee Replacement Surgery

Replacement is effective but requires general anesthesia, a hospital stay, weeks of restricted activity and months of physical therapy. GAE is an outpatient treatment done under light sedation with a puncture the size of an IV site.

GAE vs. Radiofrequency Ablation

Radiofrequency ablation targets the nerves carrying pain signals from the knee. It can help, but it does not reduce inflammation.

What Makes Orange County Interventional Radiology Different

Our practice is led by Dr. Kevin Burns and Dr. Jimmy Ton, both board-certified, fellowship-trained interventional radiologists who specialize in image-guided, minimally invasive care. We use the same advanced imaging that is used in major academic centers, but in a more personalized environment. Our patients always receive a full candidacy evaluation before anything is scheduled, including a review of imaging and prior treatments. GAE is covered by Medicare and most major insurance plans, and we coordinate directly with referring orthopedic providers for more cohesive care.

Schedule a GAE Consultation in Orange County

If chronic knee pain is limiting how you move, work, relax or sleep, GAE may be worth considering before you commit to surgery. Call Orange County Interventional Radiology at 949-916-3134 or book online to schedule at our Lake Forest, Mission Viejo or Irvine locations.