New clinical evidence is strengthening the case for genicular artery embolization as a treatment for knee osteoarthritis.
Clinical evidence proving the success of genicular artery embolization remained mixed, causing skepticism about it within the orthopedic community. However, in June, researchers published a new multi-year study in Radiology proving the decades-old procedure may be a good treatment option for osteoarthritis. The study showed that the procedure caused significant improvements in its treated patients. It helped to improve pain, physical function and quality of life.
“We believe these results carry real weight because they come from real-world data,” said Dr. Florian Fleckenstein, who’s a radiologist and deputy head of Interventional Radiology Campus Mitte, Charité – Universitätsmedizin Berlin. “With this broad, inclusive study design, our participants are exactly the patients that physicians encounter every day in their practices.”
What Is Genicular Artery Embolization?
Genicular artery embolization is a minimally invasive treatment for knee osteoarthritis that targets abnormal blood vessels associated with inflammation. The concept behind genicular artery embolization is based on targeting abnormal blood vessels that develop around an arthritic knee.
Researchers believe these vessels contribute to inflammation, amplify pain signaling, and drive changes within the arthritic joint. The procedure aims to reduce blood flow to these abnormal vessels may decrease inflammation and disrupt pain pathways. This potentially improves symptoms in patients with knee osteoarthritis.
Fleckenstein shared that treated patients experienced less pain and improved daily activities, sports, and recreation after the procedure.
“Our study demonstrates that GAE using rapidly resorbable gelatin-based microspheres is a safe, minimally invasive therapy that provides meaningful pain relief and functional improvement in participants with osteoarthritis-related knee symptoms for at least 12 months,” Fleckenstein explained. “By embolizing the pathological vessels, we’re able to normalize the vessel structure — and, in turn, the neuronal structure of the knee.”
New Medical Guidance Reflects Growing Confidence In Genicular Artery Embolization
Early randomized controlled trials found a mixed effect with patients, which ultimately stalled clinical adoption and investment. As new, emerging evidence continues to produce favorable results, professional societies are beginning to endorse the procedure.
The Society of Interventional Radiology’s recently released a position statement supporting the use of genicular artery embolization. The group recommended the procedure as a “minimally invasive treatment option for appropriately selected patients with symptomatic knee osteoarthritis who have not responded to conservative therapies and who are not candidates for, or choose not to undergo, total knee arthroplasty.”
While the group acknowledged that progress has been made, they group also noted the need for further research. They emphasized the need for the procedure to be performed by trained interventional radiologists within a multidisciplinary care model.
“While more studies need to be done, the current evidence strongly supports GAE as another tool to fight KOA pain,” said Dr. Saher S. Sabri, president of the Society of Interventional Radiology.
Early Skepticism Is Anchored On Mixed Clinical Evidence
While interventional radiologists have embraced growing evidence for genicular artery embolization, orthopedic organizations remain cautious. Major orthopedic guideline groups have not yet incorporated the procedure into standard knee osteoarthritis treatment recommendations.
Interventional radiologist Dr. Yuji Okuno from Japan is credited with pioneering the modern use of genicular artery embolization. He first applied the technique in 2013 for chronic tendinopathy and later expanding its use to knee osteoarthritis. His early studies helped generate interest in the procedure as a potential minimally invasive treatment for arthritis-related knee pain.
However, researchers in the United States and Europe found mixed results when they conducted randomized controlled trials. Some studies reported meaningful improvements in pain and function, while others could not replicate the clinical benefit separate from placebo responses.
The mixed results surrounding genicular artery embolization prompted researchers to refine both the procedure and the way it is studied.
Now, contemporary trials examine the procedure using evolved techniques. The newer studies also tend to capture larger real-world patient databases and broader patient populations.
Advances In The Genicular Artery Embolization Procedure
Advances in procedural techniques and embolization materials have changed how doctors perform the procedure. Physicians are now able to precisely target the abnormal blood vessels associated with knee osteoarthritis with new technology.
In his early studies, Dr. Okuno used a temporary embolic approach involving medication-based particles designed to briefly block abnormal vessels before gradually dissolving. Today, the field has transitioned to highly precise, bio-engineered embolic agents. These advances have allowed physicians to more effectively target abnormal vascular changes while refining treatment protocols and patient selection.
Interventional radiologists now commonly use temporary and permanent microspheres or calibrated beads designed to provide more predictable and targeted vessel blockage.
Adoption Grows As Evidence And Access Barriers Evolve
The continued evolution of genicular artery embolization represents a potential new treatment option for patients living with chronic knee osteoarthritis pain who opt out of surgical intervention.
As clinical evidence continues to grow, another challenge remains: expanding access to the procedure. A major step toward broader clinical adoption came when the American Medical Association established CPT Code 37242 as a billing pathway used for genicular artery embolization. This code helped create a standardized framework for reporting and billing the procedure.
Prior to this designation, genicular artery embolization lacked a dedicated billing pathway, often creating reimbursement challenges for physicians. However, establishing a billing code has not automatically translated into widespread insurance coverage.
Many health plans continue to restrict coverage or evaluate requests on a case-by-case basis. For example, regional Blue Cross and Blue Shield plans currently considers genicular artery embolization “experimental, investigational and/or unproven” for the treatment of knee pain.
As a result, patients seeking coverage may still need to pursue individual medical necessity reviews or exception requests.
How Will The Adoption Impact Patients?
As evidence and guidance grow, broader coverage may follow, driven by the potential for genicular artery embolization to offer an alternative to knee surgery.
For millions of people living with knee osteoarthritis, this push could expand treatment options before surgery becomes necessary. Patients who have not found relief with physical therapy, medications, or injections and who opt out of a knee replacement may soon have access to a minimally invasive alternative that reduces pain and improves mobility.
As more studies confirm its safety and effectiveness, physicians may become more confident recommending the procedure. Broader clinical acceptance could also encourage insurers to expand coverage, making the treatment more accessible and potentially improving quality of life for patients with chronic knee pain.
