Beyond Osteoarthritis: Alternative Applications and Indications for Genicular Artery Embolization

Genicular artery embolization (GAE) is a minimally invasive therapy for knee osteoarthritis (OA), originally performed in patients with recurrent hemarthrosis, that targets pathologic synovial hypervascularity and neurovascular coupling to reduce pain and inflammation. However, these biological mechanisms are not specific to degenerative disease. Synovial hyperemia, angiogenesis, and capillary fragility are also described in patients with persistent pain following total knee arthroplasty and patients with inflammatory arthritides, suggesting a mechanistic role for embolization in these patients. Advances in angiographic technique, embolic materials, and anatomic understanding have expanded the clinical application of GAE beyond OA, enabling super selective treatment of abnormal genicular branches while preserving joint perfusion. Early clinical experiences and observational studies support the feasibility and safety of embolization across a range of nonosteoarthritic knee disorders, though the evidence remains fragmented. This narrative review synthesizes the current literature on GAE for nonosteoarthritic knee pathology, emphasizing pathophysiologic rationale, technical considerations, and reported clinical outcomes to define the evolving role of embolization as a joint-preserving therapy in complex synovial diseases.