Pathophysiology of Knee Osteoarthritis and Mechanisms of Genicular Artery Embolization for Interventional...

Knee osteoarthritis (OA) is a common cause of disability worldwide, and the prevalence of OA is expected to steadily increase in the coming decades. Current treatment follows a stepwise approach, beginning with conservative measures such as physical therapy and analgesics, progressing to intra-articular injections, and knee arthroplasty reserved for advanced cases. Minimally invasive treatment options are limited and include intra-articular injections, which have mixed long-term effectiveness. Genicular artery embolization (GAE) is a novel transcatheter technique hypothesized to target pathological synovial and subchondral neovascularization, key drivers of inflammation in symptomatic knee OA. As the research on GAE has steadily increased in the last decade, it is important for interventional radiologists to thoroughly understand the pathophysiology of knee OA and how embolization disrupts the cycle of synovial inflammation and nociceptive signaling. This narrative review will examine the key pathophysiological aspects of knee OA, their relationship to pain generation, and the potential therapeutic role of GAE.