Navigating the Treatment Gap in Knee Osteoarthritis: A Comparative Review of Intra-Articular Injections, Genicular Nerve Ablation, and Genicular Artery Embolization

Abstract Knee osteoarthritis is a prevalent, debilitating condition with a therapeutic gap for patients who are refractory to conservative measures but are ineligible or unwilling to undergo surgery. Emerging interventions have been developed to attempt to fill this void, including intra-articular injections, genicular nerve ablation (GNA), and genicular artery embolization (GAE). IA injections (i.e., corticosteroids, hyaluronic acid, and platelet-rich plasma) are the least invasive of these options, but their efficacy is typically the most limited. GNA provides palliative neurolysis with longer pain relief, although it does not alter the IA microenvironment. GAE uniquely targets the inflammatory neovasculature associated with knee pain, which produces sustained pain relief in some patients. This review compares the mechanisms of action, clinical efficacy, durability, and safety profiles of these interventions and provides a framework for patient selection from an interventional radiology perspective.