Angiography images of the right knee joint of a 62-year-old participant with predominantly medial knee osteoarthritis – credit, the Radiological Society of North America / SWNS
For millions of people suffering with knee pain, a new, non-surgical procedure offers the promise of easing it away for at least 12 months with a single injection.
Genicular artery embolization, or GAE, is an emerging, minimally invasive treatment that targets abnormal blood vessels in osteoarthritis patients.
In an osteoarthritic knee, abnormal vessels build up around the joint and drive inflammation and pain. During GAE, a radiologist guides a thin catheter directly to each affected vessel and injects tiny particles to block it, calming the inflammation and easing the pain without surgery.
The injection consists of rapidly resorbable, gelatin-based microspheres designed to dissolve within hours.
“For the right patient, it can mean lasting relief from a single, minimally invasive procedure—a meaningful new option between injections and joint replacement,” said Dr. Florian Fleckenstein who lead a major trial into GAE from his research hub in Berlin, Germany.
“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.”
Osteoarthritis, the most common form of arthritis, causes inflammation, stiffness, reduced mobility, and sensory nerve pain. Knee osteoarthritis affects more than 365 million adults worldwide and is one of the leading contributors to disability, according to the World Health Organization.
“For many patients with knee osteoarthritis, there is a real treatment gap today,” Dr. Fleckenstein said, explaining that for many patients joint replacement is not an option for medical or personal reasons.
“GAE is a whole new treatment regimen that targets abnormal hypervascularity around the joint and, in turn, modulates the pathological neurovascular environment.”
The study which Dr. Fleckenstein led included 114 women and 80 men with an average age of 69, all with osteoarthritis-related knee pain who did not respond to at least 3 months of regular treatment, including physiotherapy, anti-inflammatory drugs, and intra-articular injections.
“We believe these results carry real weight because they come from real-world data. With this broad, inclusive study design, our participants are exactly the patients that physicians encounter every day in their practices.”
All participants underwent GAE with the resorbable microspheres between July and November 2024.
Around 1 in 4 participants (23%) underwent 2 GAE procedures for bilateral knee osteoarthritis, with the second GAE conducted within 4 weeks of the first procedure. In total, the patients underwent 239 GAE procedures using the resorbable microspheres.
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All the procedures were technically successful with no moderate or severe adverse events and only mild, self-limited reactions in 6.7% of the study group. A six-month follow-up was performed in person by an orthopedic surgeon.
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The case cohort, saw a significant drop in pain and a significant increase in function, including sports and recreation and daily activity
“Most importantly, their quality of life significantly increased,” said Fleckenstein.
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Pain scores fell quickly and kept improving, according to the findings published in the journal Radiology. Osteoarthritis-related symptoms also improved. At the 12-month follow-up point, 80% of the participants achieved improvements exceeding the minimum clinically important difference.
“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,” said Dr. Fleckenstein.
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“By embolizing the pathological vessels, we’re able to normalize the vessel structure—and, in turn, the neuronal structure of the knee.”
He noted that with almost 200 patients, the study is the largest body of evidence yet for GAE using rapidly resorbable microspheres – “this lets us speak about safety and efficacy with real confidence.”
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