Genicular Artery Embolization for Chronic Knee Pain: Expert Consensus Recommendations on Indications, Technique and Clinical Care Using a Delphi Process

Abstract Purpose To develop expert-consensus recommendations for patient selection, technique and clinical management in genicular artery embolization (GAE) using a Delphi process. Materials and Methods A working group developed a 75-statement questionnaire. A panel of musculoskeletal and interventional radiologists (IRs), selected based on clinical experience, scientific expertise and geographic diversity, scored each response using a 10-point Likert-scale across three rounds. Consensus was predefined as ≥ 75% of ratings ≥ 7/10. Results Twenty-nine IRs completed all three rounds. Consensus inclusion criteria for GAE include knee pain refractory to conservative treatment for ≥ 3 months due to osteoarthritis, tendinopathies or prior knee surgery and recurrent hemarthrosis (median 9[IQR 7–10]; 86% ≥ 7). Pre-procedural assessment should include standardized outcome measures, clinical examination and knee radiographs. Contrast-enhanced MRI is optional for osteoarthritis phenotyping and grading of synovitis, differential diagnosis and outcome prediction (8[7–10]; 79% ≥ 7). Via an ipsilateral antegrade transfemoral access, all visible genicular arteries should be catheterized and embolized upon detection of a hypervascular blush (9[7–10]; 76% ≥ 7). No evidence of superiority of either temporary or permanent embolic agents in terms of safety or efficacy has been demonstrated (10[8–10]; 86% ≥ 7). Structured long-term follow-up is recommended, with clinical success defined as achievement of the minimal clinically important difference or individual patient satisfaction (9[7–10]; 83% ≥ 7). Contralateral or repeat GAE may be considered for bilateral knee pain, insufficient response or pain recurrence (8[7–10]; 76% ≥ 7). Conclusion This Delphi study establishes expert-derived consensus recommendations for GAE, emphasizing broad indications, patient-tailored technique and an active role of the IR in multidisciplinary longitudinal care.