A new, less invasive option for chronic knee pain is providing relief for some patients, helping them avoid major surgeries.
Cynthia Schraf-Fletcher, 74, describes her results as “remarkably” effective.
Nearly a year post-genicular artery embolization (GAE) for her right knee, she finds the improvement rivals her total knee replacement on the left leg.
“I couldn’t be more pleased,” said Schraf-Fletcher, who underwent the procedure with Dr. Leigh Casadaban, an assistant professor of radiology at the University of Colorado Anschutz School of Medicine.
She now enjoys everyday activities like gardening and using a stationary bike much more due to less pain.
Understanding Genicular Artery Embolization
GAE is an outpatient treatment that alleviates chronic knee pain by reducing blood flow to inflamed areas in the joint. It targets irregular blood vessels tied to inflammation, which can diminish swelling and discomfort.
“For treating osteoarthritis, usual options include medications, physical therapy, or maybe a steroid injection, with total knee replacement at the other end. There hasn’t been much for those stuck in between,” Casadaban explained. “GAE serves as a promising minimally invasive option for those who have not found relief with conservative treatments but aren’t ready for major surgery.”
According to her, patients with mild to moderate osteoarthritis often gain the most benefit, though those with more advanced issues can still have the procedure, albeit with less lasting effects.
“About 70% of patients report amazing results; often, they reduce their pain by half or even more. We have some who feel no pain at all afterward,” Casadaban shared. “These patients, having tried numerous other treatments, are thrilled to return to their normal routines.”
After experiencing issues following knee replacement surgery, Schraf-Fletcher was keen for an alternative. Reflecting on her choice, she considers GAE to be the right path.
Procedure Details
Typically, GAE lasts between one to two hours and is done under conscious sedation.
An interventional radiology team makes a small incision in the leg’s crease. Using X-ray guidance and contrast dye, they navigate a tiny catheter through the femoral artery to the genicular arteries around the knee.
Once in place, they release small beads that block blood flow to the inflamed areas pinpointed by the patient.
Patients are observed for a few hours afterward and usually go home the same day, albeit with advice to take it easy for a few days during recovery.
Initially developed in Japan about a decade ago, GAE has gained international recognition. The FDA has labeled multiple devices related to the procedure as “breakthrough” in the U.S. since 2021.
Research Insights on Pain Relief
Ongoing research is producing positive results.
“The idea behind GAE is that it decreases inflammation in the knee joint, potentially leading to long-lasting symptom relief,” Casadaban noted. “Data from Japan shows that one outpatient procedure can offer pain relief lasting up to four years. In the U.S., we’re seeing two-year data that indicates if a patient responds well, relief can also last that long. This suggests we may be changing something in the joint itself.”
Casadaban is currently directing two clinical trials at CU Anschutz. One study looks at changes in knee fluid after GAE, while the other investigates a temporary device named Nexsphere-F, which blocks small vessels in the knee that might contribute to pain and inflammation.
Potential Beyond Knee Osteoarthritis
Osteoarthritis affects millions globally and can involve many joints.
While GAE is currently applied only for knee issues, Casadaban mentioned that researchers are starting to consider its use for other painful musculoskeletal conditions, like frozen shoulder, tennis elbow, and plantar fasciitis.
