532 - Midterm Clinical Outcomes of Genicular Artery Embolization for Osteoarthritis-Related Knee Pain in a Single-Center Outpatient Practice

Purpose: Knee osteoarthritis (OA) is the most common form of arthritis worldwide, and conventional therapies often provide only short-term relief with high retreatment rates, particularly among obese and morbidly obese patients who are not candidates for total knee arthroplasty (TKA). Genicular artery embolization (GAE) has emerged as a minimally invasive alternative for patients with persistent symptoms despite conservative treatment. This study aimed to assess the effectiveness of GAE in improving knee pain and function at 1-, 3-, and 6-month post-procedure in a real-world cohort of predominantly obese and morbidly obese patients with moderate to severe OA, the majority presenting with severe disease.

Materials and Methods: This was a retrospective analysis of 158 patients who underwent 194 GAE procedures at a single outpatient center between March and December 2024. The cohort had a mean age of 60 ± 10.5 years and Kellgren–Lawrence (KL) scores ranged from 0 to 4, with 48.5% of patients at KL grade 4. BMI ranged from normal to obese, the largest proportion (70.2%) being obese, including 32.9% morbidly obese. Genicular arteries with angiographic hypervascularity were embolized using permanent microspheres or resorbable particles. WOMAC and VAS scores were collected at baseline and at 1-, 3-, and 6-months post-procedure. The Minimal Clinically Important Difference (MCID) was ≥20% improvement, the Substantial Clinical Benefit (SCB) was ≥50% improvement, and combined success was defined as achieving MCID or SCB in both WOMAC and VAS.

Results: Significant reductions were observed in WOMAC (45.8%, 41.1%, 45.9%; p< 0.0001) and VAS (52.7%, 42.3%, 42.8%; p< 0.0001) at 1-, 3-, and 6-months post-GAE. For WOMAC, MCID was achieved by 80.1%, 75.3%, and 71.6% of patients, while SCB was achieved by 46.6%, 38.1%, and 52.7%. For VAS, MCID was reached by 82.4%, 78.2%, and 76.2% of patients, while SCB was achieved by 67.1%, 67.3%, and 69.1%. Combined success was achieved by 88.1%, 80.2%, and 75.6% of patients for MCID, and 62.9%, 55.7%, and 61.5% for SCB.

Conclusion: In our cohort, composed mostly of morbidly obese patients refractory to conventional treatments and total knee arthroplasty (TKA), GAE produced substantial and sustained improvements in knee pain and function up to 6 months. These findings support GAE as an effective OA treatment option, with longer follow-up needed to assess durability and retreatment rates.

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