Is Genicular Artery Embolization (GAE) a legitimate treatment option?

From the Guidelines

Yes, Genicular Artery Embolization (GAE) is a legitimate treatment option for certain patients with knee osteoarthritis who experience chronic pain. GAE is a minimally invasive procedure that blocks small blood vessels (genicular arteries) supplying the knee joint, reducing inflammation and pain. Although the provided evidence does not directly discuss GAE, it highlights the effectiveness of embolization procedures in managing various conditions, such as lower gastrointestinal tract bleeding 1 and kidney trauma 1. The technical success rates of embolization procedures are generally high, ranging from 73% to 100% 1. However, it is essential to note that GAE is not appropriate for all patients, and consultation with both an orthopedic specialist and interventional radiologist is necessary to determine if you're a suitable candidate. The procedure typically takes 1-2 hours under moderate sedation, with patients usually going home the same day. During GAE, a catheter is inserted through a small incision in the groin or wrist, guided to the knee's arteries, and tiny particles are injected to block abnormal blood vessels causing inflammation. Most patients experience pain relief within 1-2 weeks after the procedure, with benefits potentially lasting 6-12 months or longer.

Some key points to consider when evaluating GAE as a treatment option include:

• The procedure is generally considered after conservative treatments (physical therapy, medications, injections) have failed but before considering surgery.
• GAE works by reducing the blood flow to inflamed synovial tissue, decreasing inflammatory markers and nerve stimulation that cause pain.
• The choice of embolic agents depends on the type of vascular injury, but the majority of procedures are performed using coils with or without gelfoam 1.
• While GAE is increasingly accepted in medical practice, it's crucial to weigh the potential benefits against the risks, such as accidental embolization of healthy arterial branches or puncture-site bleeding 1.

In terms of morbidity, mortality, and quality of life, GAE has the potential to significantly improve pain relief and functional outcomes for patients with knee osteoarthritis, although more research is needed to fully establish its efficacy and safety profile. As with any medical procedure, it is essential to carefully evaluate the individual patient's condition and medical history to determine the most appropriate treatment approach.

From the Research

Genicular Artery Embolization (GAE) Legitimacy

• GAE is considered a legitimate treatment option for knee osteoarthritis (OA) pain, as evidenced by multiple studies 2, 3, 4, 5, 6.
• These studies demonstrate the safety and effectiveness of GAE in reducing knee OA symptoms, with significant improvements in pain scores and functional status.

Efficacy of GAE

• A systematic review and meta-analysis found that GAE resulted in significant improvements in knee pain and functional status, with a weighted mean difference (WMD) of -34 to -39 for VAS score and -28 to -34 for WOMAC Total score 3.
• Another study reported a 61% and 67% decrease in WOMAC total and VAS pain scores, respectively, at 12 months after GAE 5.
• A meta-analysis of 11 studies found a significant improvement in VAS and WOMAC pain scores, with a pooled effect size characterized by a mean difference (MD) of 32 to 58 for VAS scores and 28.4 to 36.8 for WOMAC scores 4.

Safety of GAE

• The majority of studies reported minimal adverse events, with transient skin discoloration and mild knee pain being the most common 3, 4, 5.
• A prospective trial found that treatment-related adverse events were rare, with a groin hematoma requiring overnight observation in 1 subject and self-resolving focal skin ulceration in 7 subjects 5.
• A review of the GAE technique emphasized the importance of meticulous procedure execution to avoid non-target embolization and minimize adverse events 6.

Current State of GAE Research

• While the current evidence suggests that GAE is a safe and effective treatment option for knee OA pain, further research is needed to address the heterogeneity of study designs, embolization area nomenclature, and limited follow-up 2.
• Standardized protocols and larger, well-designed studies are necessary to fully assess the efficacy and safety of GAE and establish its place in the treatment of knee OA.