Technique, Safety and Adoption of Genicular Artery Embolization for Knee Osteoarthritis: A Nationwide Analysis of the German Quality-Assurance Registry

Abstract Purpose To evaluate the nationwide adoption of genicular artery embolization (GAE) in Germany and to describe patient selection, technique, safety and radiation dose. Materials and Methods We retrospectively analyzed procedures recorded in the quality-assurance registry of the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR), from January 2024 to December 2025. Technical success, entered per procedure, was defined as subjective adequate devascularization of the synovial blush. Complications were graded using the modified CIRSE classification, and radiation exposure was expressed as dose-area product (DAP) and fluoroscopy time. The analysis was primarily descriptive. Results Overall, 2335 procedures in 2209 patients across 109 centers in 15 federal states were recorded (median age 67 years, IQR 59–77; 57% female; prior total knee arthroplasty (TKA) in 300, 13%). Annual volume rose from 579 procedures in 2024 to 1,756 in 2025, and the embolic agent shifted from permanent (40–21%) toward temporary microspheres (4–29%). Center-reported technical success was 93% (87% in 2024, 94% in 2025). Eleven complications were recorded (0.5%), all CIRSE grade 1–3, with no permanent sequelae; none were recorded in 2024. Median DAP was 1536 cGy cm 2 (IQR 731–3048) and median fluoroscopy time 24 min (IQR 16–34). Conclusion During rapid nationwide adoption, GAE was performed for osteoarthritis-related and post-TKA pain with low radiation dose and high center-reported technical success across centers of all volumes, supporting its feasibility in routine practice. The complication rate is a lower limit, as the registry is not designed for complication surveillance.