Genicular artery embolization for treating knee osteoarthritis - an overview of the evidence

Genicular artery embolization (GAE) is an emerging, minimally invasive procedure for treating knee osteoarthritis (OA) that targets pain-producing neovessels and inflammation. Over the last decade, interest in GAE has grown rapidly. This descriptive review synthesizes key evidence regarding GAE's proposed mechanisms of effect, procedural techniques, effectiveness and safety. Single-arm studies and meta-analyses consistently report significant improvements in pain and function following GAE, however these are limited by the absence of comparison groups. Three placebo-controlled randomized trials have yielded mixed results, with two studies suggesting strong nonspecific effects. Effectiveness appears greater in early-stage OA, with diminishing effects in advanced disease. Animal studies and preliminary human imaging data support anti-inflammatory effects, although causal links in humans remain unconfirmed. Procedural variables such as embolic agent type and number of arteries treated appear to influence outcomes and adverse events. Biodegradable agents may offer improved safety profiles compared to permanent materials, though conclusive comparative data are lacking. Most complications reported to date have been minor and self-limiting, including transient skin ischemia and procedural pain. Looking ahead, carefully designed, large-scale trials with standardized protocols, biomarkers, and longer follow-up are needed to define GAE's role in OA management and to determine whether it provides benefits beyond placebo.