Interventional Radiology


Genicular Artery Embolization (GAE): New Knee Replacement Technology

Starting in 2021, there is exciting news for patients looking for an alternative to knee replacement surgery. It is a procedure called genicular artery embolization, and it is used to treat osteoarthritis/degenerative disc disease.

A recent study (2020) shows that the procedure is effective at significantly reducing patient pain, particularly those dealing with moderate-to-severe knee pain. The study showed continued improvement at each of the one-month, three-month, and six-month checkups, which included an MRI scan. Patients felt the increased improvement over time, and the MRI showed it. Another 2020 study tested 10 patients that received GAE treatment. At the 12-month mark, patients reported:

• Median pain: 15.4% improvement

• Knee/leg function: 21.3% improvement

• Quality of life: 100% improvement

Follow-up tests were completed, namely a six-minute walk and 30-second chair stand test. Scores forwalk and chair stand tests improved by 26% and 43% respectively. No adverse reactions were reported as well.

What is Genicular Artery Embolization? Abnormal blood vessel formation is one of the causes of knee pain in osteoarthritis patients. Increased angiogenesis (the formation of new blood vessels) that breach into avascular cartilage in the knee is a hallmark of osteoarthritis, so much so that it is one of the diagnostic features of the disease. GAE is an interventional radiology treatment that can relieve osteoarthritis pain by treating the offending abnormal blood vessels. The procedure blocks the abnormal blood vessels. Doing this reduces inflammation and its resultant pain.

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Procedure Process

What to Expect

Patients should ensure that previous imaging studies have been sent either to Advanced Medical Imaging or the hospital and received. The procedure cannot be done without them. Patients should inform the scheduling staff if they are taking blood thinners, have medication or other allergies, or have other significant health problems. Patients should not to eat or drink after midnight before the procedure. Patients will need to bring a driver as they will not be able to drive home after receiving intravenous medications. A routine laboratory blood check may be needed if one has not been performed recently.

On the day of the injection, patients should not drive and should limit activities.

During Procedure

Our IR physicians will insert a small catheter (a thin hollow tube) into the artery of the patient’s upper thigh and, with the use of X-rays, guide the catheter to the arteries supplying the lining of the knee. Tiny particles are then injected through the catheter into these arteries, reducing the blood supply. This in turn reduces the inflammation associated with osteoarthritis, which alleviates the pain.

After the Procedure

Immediately afterwards, a CT scan may be taken so that the anatomy of the disc can be better appreciated. The results will be discussed with the patient before they leave and a report will be forwarded to their physician.

Over the next 2-3 days, muscles may be sore and the usual pain may be aggravated. Ice will usually be more helpful than heat during this period. Regular pain medicine can be taken as prescribed. On the second to third day, patients may return to regular activities. Soreness should improve by the third day and pain should go back towards the baseline level. When pain is improved, patients should start their regular exercises/activities in moderation.

Frequently Asked Questions

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What is the success rate of genicular artery embolization?

In 10 groups (9 studies; 270 patients; 339 knees), GAE technical success was 99.7%. Over 12 months, the WMD ranged from −34 to −39 at each follow-up for VAS score and −28 to −34 for WOMAC Total score (all p ​< ​0.001).

AM I a candidate for GAE?

Knee pain affects around 32 million Americans every day! Many doctors prescribe geniculate artery embolization to their patients because of the following advantages: Outpatient (same-day) procedure, thus No overnight hospital stays Minimal post-procedural pain No prolonged recovery period Minimally-invasive Does not preclude you from subsequently having any other procedure or surgery May help reduce reliance on pain medication

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