149 - Expanding the Evidence: Genicular Artery Embolization for Mild-to-Moderate Knee Osteoarthritis in a 30-Patient Prospective Cohort – Safety, Efficacy, and Functional Outcomes
Professor NIMS Medical and Research institute, Jaipur, India
Purpose: Genicular artery embolization (GAE) has emerged as a novel endovascular therapy that targets synovial hypervascularity and inflammation, thereby disrupting the pain–angiogenesis feedback loop. Early pilot studies demonstrated promising efficacy and safety, yet sample sizes have been small. This study expands the evidence by evaluating GAE in a larger 30-patient cohort with mild-to-moderate knee OA.
Purpose The primary purpose of this study was to investigate the efficacy and safety of GAE using calibrated microspheres in patients with mild-to-moderate knee OA who were refractory to conservative management. Specifically, we aimed to:
Quantify changes in pain intensity (Visual Analog Scale, VAS).
Assess functional improvement using validated PROMs (KOOS, WOMAC) and objective performance tests.
Explore the impact of GAE on physical activity levels (IPAQ) and bone mineral parameters (DEXA).
Document analgesic/NSAID usage post-treatment.
Evaluate the safety profile and spectrum of adverse events.
Materials and Methods: In this prospective single-center study, 30 patients (Kellgren–Lawrence grades 1–3) with VAS >50 mm underwent GAE using 100–300 µm microspheres. Primary endpoint was VAS pain at 6 months. Secondary outcomes included KOOS, WOMAC, IPAQ, physical performance tests, DEXA scans, medication use, and adverse events
Results:
Technical success was 93% (28/30). Median VAS decreased from 65 mm to 38 mm at 6 months (p< 0.001), with 76% achieving ≥50% reduction. KOOS and WOMAC scores improved significantly (both p< 0.001). Objective tests showed 35% more chair-stand repetitions and 28% faster stair climb. IPAQ activity improved nonsignificantly; NSAID use decreased by 40%. No significant DEXA changes were observed. Adverse events were minor and transient (10% groin hematoma, 17% skin discoloration, transient post-procedural pain). No severe complications occurred.Discussion
Importantly, our study highlights the need for systematic patient selection. Patients with severe OA (Kellgren–Lawrence grade 4), advanced meniscal degeneration, or mechanical malalignment are less likely to benefit, as vascular-driven pain plays a smaller role in advanced disease. Future trials should stratify outcomes by radiographic severity.
Conclusion: GAE provided substantial pain relief, functional improvement, and favorable safety in mild-to-moderate knee OA. It may serve as a minimally invasive option bridging conservative care and arthroplasty. Larger randomized trials are needed to confirm long-term efficacy and optimize patient selection.
