Genicular arterial embolization in knee osteoarthritis: Current evidence, clinical outcomes, and future perspectives

Background and Aims: Genicular Arterial Embolization (GAE) has recently emerged as a minimally invasive and innovative intervention for the management of knee osteoarthritis (OA), a prevalent and debilitating condition often resistant to conventional therapies. This review synthesizes current evidence on the mechanistic rationale, procedural techniques and risk–benefit profile of GAE in patients with persistent joint pain unresponsive to conservative management. Materials and Methods: A comprehensive narrative literature search was performed using “Google Scholar,” “PubMed,” and “Scopus,” including publications from January 2005 to March 2025. Search terms included “genicular artery embolization,” “knee osteoarthritis,” “pain management,” and “synovial vascularity.” Relevant clinical studies, mechanistic research and expert recommendations on patient selection, procedural approaches, embolic materials and outcomes were evaluated. Findings from published literature indicate that advancements in imaging guidance and patient-selection strategies have enhanced procedural precision and therapeutic efficacy. Results: Evidence consistently demonstrates sustained pain reduction, improved joint function and delayed need for surgical intervention in appropriately selected patients. GAE is generally well tolerated, with predominantly mild and self-limiting adverse effects. Despite encouraging short- and mid-term outcomes, variations in study methodology and embolization techniques highlight the need for procedural standardization and long-term validation. Conclusion: GAE represents a promising addition to multimodal osteoarthritis management by targeting synovial hypervascularity and inflammatory pain pathways. While early outcomes are encouraging, further large-scale, long-term studies are required to validate effectiveness, refine patient-selection criteria and establish standardized clinical guidelines for broader adoption.