Knee osteoarthritis (OA) is one of the most common chronic joint conditions. It occurs when the cartilage in the knee breaks down over time, leading to pain, stiffness, and swelling. Moving your knee becomes increasingly difficult as OA progresses, making daily activities like walking or climbing stairs more challenging. The condition can also cause inflammation and changes in the bone structure around the joint. Currently, it affects around 32 million people in the U.S.
Current treatments for arthritis and their limitations
Several treatment options exist for knee arthritis, but they often come with limitations:
- Physical Therapy: While it can benefit some patients, it can have limited results. This is especially true for those with advanced arthritis.
- Corticosteroid Injections: These injections can offer temporary relief. The effects typically last only a few weeks to months.
- Knee Replacement Surgery: This invasive procedure provides a more permanent solution. However, it carries risks such as long recovery times and potential complications.
- Hyaluronic Acid (HA) Injections: HA injections provide lubrication and cushioning in the knee joint. While some patients report temporary relief, the effectiveness can vary. The results typically last a few weeks to months.
What is genicular artery embolization?
Genicular Artery Embolization (GAE) is a minimally invasive procedure designed to relieve knee pain caused by OA. It works by selectively blocking blood flow to inflamed areas of your knee joint. The genicular arteries are small blood vessels that supply blood to the synovial membrane of the knee. Genicular artery embolization helps reduce inflammation and pain associated with OA by blocking blood flow to the synovium, which is the tissue that lines the knee joint.
A catheter is inserted through a small incision in your thigh during the procedure. This is guided by fluoroscopy (real-time X-ray imaging). Tiny particles or microspheres are injected into the targeted arteries to block blood flow, reducing inflammation in your knee joint. This procedure is performed outpatient, usually in less than an hour, with immediate return to activity.
Who can benefit from genicular artery embolization?
The GAE procedure is particularly beneficial for people who:
- Have moderate to severe knee pain due to OA.
- Are between 40 and 80 years old.
- Have not found relief from conservative treatments such as NSAIDs (non-steroidal anti-inflammatory drugs), physical therapy, or corticosteroid injections.
- Are either unwilling or ineligible for knee replacement surgery.
If you have advanced arthritis, as indicated by X-ray findings, this procedure may not be for you.
How does the procedure work?
The GAE procedure aims to relieve knee pain associated with OA. It is typically an outpatient procedure. This means you will not need general anesthesia and recover quickly.
Here’s what to expect:
Preparation
Before the procedure, you will have a thorough evaluation. This includes imaging studies like XRAYS, MRI or CT scans. These tests help determine the condition of your knees and identify which genicular arteries are involved. You may need to fast for several hours on the day of the procedure and should wear comfortable clothing.
Sedation
You will receive moderate sedation through an intravenous (IV) line, keeping you relaxed and comfortable without needing general anesthesia. Local anesthesia is applied to numb the catheter’s insertion area, usually in your groin.
Catheter insertion
A small incision (about 1-2 mm) is made in your groin area. A thin catheter is carefully inserted into the femoral artery.
The vascular surgeon guides the catheter through the femoral artery towards the genicular arteries.USING real-time X-ray imaging to visualize blood vessels, ensuring precise navigation.
Imaging guidance
Once the catheter is in place, advanced imaging techniques are used to identify and confirm the location of the genicular arteries supplying blood to your knee.
An initial angiogram may be performed by injecting a contrast dye through the catheter. This helps visualize blood flow and identify any abnormalities or areas of inflammation within your knee joint.
Knee embolization
After identifying the target arteries, tiny particles (embolic agents) are injected into selected genicular arteries through the catheter. Embolic agents, typically made from microspheres or gelatin sponge particles, are assigned to effectively block blood flow.
The vascular surgeon introduces these particles into the target arteries, which then impede blood flow to the inflamed areas of the synovial membrane in the knee. This process reduces inflammation and pain signals, leading many people to experience significant relief from pain.
Post-procedure monitoring
Once embolization is complete, you will be monitored briefly in a recovery area. Medical staff will check your vital signs and monitor for complications like bleeding or allergic reactions. Most patients can walk within a few hours after the procedure.
After about one hour of observation, you will be discharged home on the same day with instructions for care and activity restrictions.
Recovery and follow-up
The entire GAE procedure generally takes about one to two hours from start to finish. While some people may begin seeing pain relief within days of undergoing genicular artery embolization, full effects can take up to two weeks as inflammation decreases.
- Post-Procedure Care: Mild bruising or soreness at the catheter insertion site is common. You should avoid strenuous activities and rest for one or two days before returning to work or normal activities.
- Follow-Up Appointments: Regular follow-ups may be scheduled to monitor your progress and assess pain levels.
Potential risks and complications
Like any medical procedure, the GAE procedure carries some risks. Common side effects can include bruising or mild pain at the catheter site.
What to expect during and after the procedure
You can expect a relatively straightforward experience when undergoing genicular artery embolization:
- During the Procedure: Most patients report minimal discomfort due to local anesthesia and sedation.
- Post-Procedure Care: You may experience mild discomfort or bruising at the injection site. Over-the-counter pain relievers can help manage any pain. It’s important to avoid strenuous activity for a few days to allow the procedure to take effect.
- Long-Term Improvement: Most patients notice significant improvements in pain levels lasting at least one year following genicular artery embolization, with average pain scores dropping significantly after treatment.
Patients with mild to moderate OA have been shown to benefit the most from genicular artery embolization. Most patients notice significant pain relief.
When to consult a doctor
If you suffer from chronic knee pain, consult your healthcare provider if:
- You have persistent pain not relieved by conservative treatments.
- Your mobility is significantly affected by knee discomfort.
- You want to explore alternative options like genicular artery embolization for relief without surgery.
The genicular artery embolization procedure targets the sources of knee pain by blocking blood flow to inflamed areas. At Empire Vein and Vascular Specialists, our expert team is committed to providing effective pain relief through this innovative procedure. We understand how knee pain can impact your daily life. Our board-certified vascular surgeons use their extensive expertise in vascular surgery and non-invasive treatments to deliver personalized care tailored to your unique needs. Additionally, most of our treatments are covered by insurance, and we’ll work directly with your provider to help secure coverage.
If you want to learn more about our treatment options, contact Empire Vein Specialists to schedule a consultation or call us at 1-800-VARICOSE today.