Interventional Radiology for Knee Pain Management

Genicular Artery Embolization (GAE) and Genicular Nerve Ablation (GNA)

Genicular artery embolization (GAE) and Genicular nerve ablation (GNA) are a minimally invasive procedure providing pain relief for most patients with osteoarthritis (OA). OA in the knee is the most common joint disease in the world. Adults will develop knee pain from aging or from injury-related breakdown of cartilage in the knee joint.

If physical therapy, medications, and joint injections are not helpful, the most common treatment has traditionally been surgical knee replacement. For those patients who are not candidates for knee replacement surgery, those who do not want knee replacement surgery, or those who have had knee replacement surgery and still have some pain, GAE or GNA may be an option to treat your knee pain.

Genicular artery embolization reduces blood flow to the joint surface, called the synovium, which is often inflamed due to OA. An interventional radiologist inserts a small tube into an artery in the patient’s thigh. Guided by X-rays, they maneuver this tube through the arteries to the vessels that supply blood to the inflamed parts of the joint. They then inject small particles into affected blood vessels, this reduces inflammation and lessens pain. The procedure is performed under sedation, and patients return home the same day with only a Band-Aid on their thigh.

Pain reduction begins as the inflammation subsides and can last up to two years.

Genicular nerve ablation is a heat-based therapy that targets the nerves responsible for pain sensation to the knee joint space. Our Interventional Radiologists (IR) use real time Xray guidance to target these specific nerves. First, the interventional radiologist performs a test nerve-block to learn whether GNA will be effective. This is performed by placing small needles at the site of the nerves and injecting local anesthetic. After 30 minutes, if the patient reports a 50% or greater reduction in pain, we schedule the GNA.

The ablation procedure is like the test-block, but rather than blocking the nerve with a temporary local anesthetic, the nerve conduction is disrupted using heat-based needles while under sedation. Similar to GAE, pain reduction can last up to two years. We can repeat the ablation procedure safely after six months if pain returns.