Genicular artery embolization for symptomatic knee osteoarthritis: A narrative review

Abstract

Knee osteoarthritis (KOA) is a highly prevalent and debilitating condition associated with substantial physical, psychological, and socioeconomic burden. For patients in whom conservative therapy has failed and who are unable or unwilling to undergo arthroplasty, treatment options remain limited. Genicular artery embolization (GAE) has emerged as a minimally invasive investigational therapy performed by interventional radiologists and vascular specialists which targets the synovial inflammation and pathological neo-angiogenesis central to KOA pathophysiology. Preclinical studies, imaging analyses, and biomarker data support the mechanistic rationale for GAE, demonstrating reductions in synovitis, hypervascularity, and inflammatory mediators. Existing clinical studies report high technical success rates, reported improvements in pain and function, and low complication rates following GAE. However, current evidence remains limited by the predominance of single-arm studies and the substantial placebo response associated with interventional pain procedures. Notably, three randomized sham-controlled trials have demonstrated mixed results, with one study showing significant benefit and two showing no significant difference compared with sham intervention. Multiple ongoing sham-controlled and investigational device exemption (IDE) trials are expected to better define the true treatment effect, optimal patient selection, and long-term role of GAE within evidence-based KOA management.