Genicular artery embolization and nerve ablation: Interventional radiology solutions for osteoarthritis related knee pain

Osteoarthritis (OA) is a major cause of chronic knee pain, with treatment options ranging from conservative therapies to total knee replacement. Minimally invasive, image-guided interventions such as genicular artery embolization (GAE) and genicular nerve ablation (GNA) have emerged as alternatives for patients with refractory OA-related pain. This review explores these techniques and the role of interventional radiologists in multidisciplinary OA management. This narrative review synthesizes current evidence on the safety, efficacy, and technical aspects of GAE and GNA. GAE selectively embolizes genicular arteries supplying the knee joint and synovium, reducing synovitis by targeting abnormal neovascularity and hyperemia. The procedure is performed under fluoroscopic guidance and clinical studies have reported significant improvements in pain. GNA can be performed with ultrasound or fluoroscopic guidance. This technique utilizes radiofrequency ablation (RFA) to denervate sensory nerves thereby alleviating knee pain. Conventional, pulsed, and cooled RFA techniques are available and have demonstrated neuro-ablative effects. GAE and GNA have demonstrated high technical and clinical success, with significant reductions in Visual Analog Scale (VAS) pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and other patient reported outcome measures. Pain relief usually lasts from 6 to 12 months, with GAE benefits reported up to 24 months. Both procedures exhibit favorable safety profiles, with mostly mild, self-limiting adverse events. GAE and GNA are effective minimally invasive options for patients who are not candidates for or unwilling to undergo knee replacement. Further randomized placebo-controlled trials are needed to confirm long-term efficacy for these interventions.