A new study suggests a minimally invasive knee procedure could give some osteoarthritis patients lasting relief, without surgery.
Research published on June 16 in Radiology found that genicular artery embolization, or GAE, reduced pain and improved function for people with osteoarthritis-related knee pain for at least 12 months.
Osteoarthritis is the most common type of arthritis and a major cause of disability worldwide. The World Health Organization estimates that more than 365 million adults around the world live with knee osteoarthritis.
“For many patients with knee osteoarthritis, there is a real treatment gap today,” said Florian Nima Fleckenstein, M.D., deputy head of Interventional Radiology Campus Mitte, Charité, Universitätsmedizin Berlin. “Conservative measures such as intra-articular injections no longer provide sufficient relief, but joint replacement is not an option for medical or personal reasons.”
GAE is a nonsurgical procedure that targets abnormal blood vessels that develop around arthritic knee joints. These excess vessels are believed to contribute to ongoing inflammation and pain. During the procedure, an interventional radiologist uses a thin catheter to reach the affected blood vessels and injects tiny particles that block blood flow to them.
The study looked at GAE performed with rapidly resorbable, gelatin-based microspheres. The particles are calibrated by size and dissolve within hours after being delivered.
“GAE is a whole new treatment regimen that targets abnormal hypervascularity around the joint and, in turn, modulates the pathological neurovascular environment,” Dr. Fleckenstein said. “By reducing both inflammation and pain, GAE with resorbable microspheres may be the first procedure that alters the course of the disease, slowing its progression.”
The prospective single-center study enrolled 194 patients with osteoarthritis-related knee pain, including 114 women and 80 men. All had failed to get enough relief after at least three months of conservative treatment, including physiotherapy, anti-inflammatory medications, and intra-articular injections.
Participants had a median age of 69 years and a median body mass index of 28.4. All underwent GAE using the resorbable microspheres between July and November 2024.
Forty-five participants, or 23 percent, received treatment in both knees, with the second procedure performed within four weeks of the first. Researchers carried out 239 GAE procedures in total, using fluoroscopic guidance.
Every procedure was technically successful. No moderate or severe adverse events occurred, and 6.7 percent of participants had mild reactions that resolved on their own.
“We believe these results carry real weight because they come from real-world data,” Dr. Fleckenstein said. “With this broad, inclusive study design, our participants are exactly the patients that physicians encounter every day in their practices.”
Researchers assessed patients before treatment and again at six weeks, three months, six months and 12 months. Follow-up rates were 94 percent at six weeks, 89 percent at three months, 89 percent at six months and 79 percent at 12 months.
Pain levels improved quickly and stayed lower over time. On the 0-to-10 Numeric Rating Scale, the median score fell from 7 before treatment to 4 after six weeks, then to 3 at both the six-month and 12-month follow-ups.
Patients also improved across every category of the Knee Injury and Osteoarthritis Outcome Score. Median scores for daily activities rose from 53 to 71.5, sports and recreation from 15 to 36, symptoms from 51 to 68, pain from 44 to 65, and quality of life from 19 to 40.
“In our cohort, we saw a significant drop in pain and a significant increase in function, including sports and recreation and daily activity,” Dr. Fleckenstein said. “Most importantly, their quality of life significantly increased.”
The study said a drop of at least 2 points on the Numeric Rating Scale and an increase of at least 10 points in Knee Injury and Osteoarthritis Outcome Score sub-scores represent clinically meaningful improvement. At the 12-month follow-up, 80 percent of participants exceeded that threshold based on their Numeric Rating Scale pain scores.
“Our study demonstrates that GAE using rapidly resorbable gelatin-based microspheres is a safe, minimally invasive therapy that provides meaningful pain relief and functional improvement in participants with osteoarthritis-related knee symptoms for at least 12 months,” Dr. Fleckenstein said. “By embolizing the pathological vessels, we’re able to normalize the vessel structure, and in turn, the neuronal structure of the knee.”
According to Dr. Fleckenstein, the study is the largest body of evidence so far examining GAE with rapidly resorbable microspheres, involving nearly 200 patients.
“This lets us speak about safety and efficacy with real confidence,” he said. “For the right patient, it can mean lasting relief from a single, minimally invasive procedure, a meaningful new option between injections and joint replacement.”
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