Key Osteoarthritis Biomarkers: What Interventional Radiologists Performing Genicular Artery Embolization Need to Know

Knee osteoarthritis (OA) is a major cause of pain and disability. Genicular artery embolization (GAE) is a promising alternative for patients unresponsive to conservative treatment or unsuitable for total knee replacement. GAE may alleviate knee pain by reducing synovitis and by causing ischemia to pathologic knee nerves. However, outcomes vary based on baseline MRI and radiographic findings, making patient selection challenging. Recently, reduction in synovitis on contrast-enhanced MRI has been associated with pain relief post-GAE. Novel OA phenotypes (inflammatory, cartilage, bone, and atrophic) can aid in patient selection by using imaging and molecular biomarkers. Moreover, imaging features such as cartilage defects, bone marrow lesions, and synovitis may predict symptomatic outcomes. This review explores OA pathophysiology, focusing on radiographic, biochemical, and imaging biomarkers in evaluating GAE for knee OA treatment.