Category: Genicular Artery Embolization (GAE)

Why Am I Still Having Knee Pain If Injections No Longer Work?

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(A Patient Friendly Guide + When Genicular Artery Embolization Procedure May Help)

Still having knee pain even after steroid or gel injections? Learn why injections stop working, what causes persistent knee pain, and how genicular artery embolization (GAE) may help when surgery isn’t an option.

Understanding Why Knee Pain Continues After Injections

Knee pain caused by osteoarthritis (OA) can be incredibly frustrating, especially when treatments that used to help stop working. Steroid injections, gel (Visco supplement) injections, or even platelet-rich plasma (PRP) can provide temporary relief. But many patients reach a point where the pain returns or never fully improves.  If this sounds familiar, you are not along. Up to 40-50% of patients eventually stop responding to injections over time. Let’s understand why this happens and wat options may still help, even if surgery isn’t possible.

Why Injections Stop Working

  1. Osteoarthritis continues to progress
    1. Injections help calm inflammation or lubricate the join, ut they cannot stop cartilage loss.
    2. As knee OA worsens:
      1. Inflammation inside the joint becomes chronic
      2. Bone spurs may form
      3. Nerves around the joint become hypersensitive
    3. Eventually, injections don’t provide enough benefit
  2. Steroid injections have diminishing returns
    1. Steroids reduce inflammation, but:
      1. The effect becomes shorter over time
      2. Steroids can weaken cartilage if used too frequently
      3. Guidelines limit them to 3-4 injections per year
    2. So for may patients, pain relief slowly fades.
  3. Gel injections don’t work well in advanced OA
    1. Hyaluronic acid injections act like lubrication, but in sever arthritis, the join is to damaged for them to be helpful.
    2. Studies show they work best in mild-moderate OA, not bone on bone disease.
  4. Pain may not be coming only from the joint
    1. OA affects the entire knee system:
    2. This explains why some patients still have pain even if imagining doesn’t look “terrible.”

If Surgery Isn’t an Option- You Still Have Options

Some patients cannot undergo knee replacement due to:

  • Medical conditions
  • Age
  • Personal preference
  • Fear of recovery
  • Prior poor surgical outcomes
  • Wanting a less invasive option

Fortunately, there is a safe and minimally invasive alternative, Genicular Artery Embolization (GAE). 

What is Genicular Artery Embolization?

Genicular Artery Embolization is non -surgical, image guided procedure performed by an interventional radiologist. Instead of treating the joint directly, GAE targets the inflammation source.

How it works:

  • Tiny particles are injected into the genicular arteries (vessels around the knee)
  • These particles reduce abnormal blood flow that drives inflammation
  • This decrease in inflammation reduces nerve irritation and pain

Most patients have not incisions, only a small pinhole in the wrist or groin.

Who is a Good Candidate?

GAE may help if you:

  • Have knee pain from osteoarthritis
  • Are not getting relief from injections
  • Are not ready or cannot have knee replacement
  • Want a procedure with minimal downtime

Studies show 60-80% of patients experience significant long term pain improvement after GAE.

What to Expect Durin the Procedure

Before:

  • You will meet with an interventional radiologist for evaluation
  • Imaging (like X-ray or MRI) confirms OA severity
  • You may undergo diagnostic testing to pinpoint pain sources

During:

  • Local numbing + light sedation
  • Catheter inserted through a tiny puncture
  • Embolization particles placed

After:

  • Same day or next-day discharge
  • Most patients walk immediately
  • Full recovery in a few days

Pain relief often improves steadily over weeks.

Frequently Asked Questions

“Will GAE fix my arthritis?”   

  • No, it reduces inflammation and pain but does not rebuild cartilage.

“How long does the relief last?”

  • Studies show improvement for 1-2 years, sometimes longer.

“Can I still get other treatments later?”

  • Yes, GAE does not prevent future surgery or injections.

When Should you Consider a Consultation?

You may benefit from evaluation if your knee pain:

  • Interferes with walking or sleep
  • Limits daily activities
  • No longer responds to steroid or gel injections
  • Prevents you from exercising
  • Affects quality of life

GAE may offer meaningful relief without major surgery.

Citations

  1. Altman RD, et al. “Recommendations for the Use or Intra-Articular Therapies in the Management of Osteoarthritis.” Osteoarthritis and Cartilage. 2015.
  2. Bagla S, et al. “Genicular Artery Embolization for the Treatment of Knee Pain Secondary to Osteoarthritis.”  Journal of Vascular and Interventional Radiology. 2020.
  3. Little MW, et at. “Genicular Artery Embolization for Osteoarthritis-Related Knee Pain: Clinical Results.” Cardiovascular and Interventional Radiology. 2021.
  4. American College of Rheumatology. “Guidelines for Management of Osteoarthritis of the Knee.” 2019.

Essential Guide to Genicular Artery Embolization: Preparation, Procedure, and Recovery

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Key Takeaways:

  • Genicular artery embolization (GAE) is a minimally invasive procedure that helps reduce knee pain by blocking blood flow to inflamed areas in the knee joint.
  • Most patients experience pain relief within one to two weeks, with long-term benefits lasting several years, making it an effective non-surgical treatment for knee osteoarthritis.
  • GAE is performed by an interventional radiologist using a small catheter and tiny particles, avoiding the need for knee replacement surgery or large incisions.
  • Recovery is quick, with patients going home the same day and returning to normal activity within a week, while avoiding strenuous exercise for a short period.

Understanding Genicular Artery Embolization (GAE)

For those dealing with chronic knee pain from knee osteoarthritis, surgery isn’t the only option. The genicular artery embolization procedure is a minimally invasive treatment that targets abnormal blood vessels in the knee lining, helping to reduce inflammation and relieve pain.

Here’s how it works: an interventional radiologist inserts a small catheter into the femoral artery and, using X-ray guidance, injects tiny particles to block blood flow to inflamed areas. This helps lower swelling and ease discomfort. According to a study published by the Society of Interventional Radiology, patients who rated their pain an 8 out of 10 before GAE saw it drop to a 3 out of 10 within a week.

With no large incisions and a faster recovery time, GAE is a non-surgical treatment option for those looking to avoid knee replacement surgery.

Who is a good candidate for GAE?

Not everyone with knee pain needs knee replacement surgery, but when physical therapy, pain medications, or knee injections stop working, it can feel like options are running out. That’s where the GAE procedure may help.

You might qualify for GAE if you:

  • Are between 45 and 80 years old
  • Have moderate to severe knee pain
  • Have been diagnosed with knee osteoarthritis on an X-ray
  • Experience knee tenderness in a specific area
  • Have tried NSAIDs, joint injections, or physical therapy without relief
  • Want to avoid or are not eligible for knee replacement surgery

For many, GAE offers a way to manage chronic knee pain without the long recovery of open surgery.

Pre-Procedure Preparations

Preparing for the genicular artery embolization procedure is essential for a smooth experience and recovery. Your doctor will assess your condition, review your medical history, and provide specific instructions to follow before the procedure.

Medical Evaluation & Consultation

Before undergoing GAE, you’ll need a full evaluation to ensure the procedure is safe and appropriate for your condition. This includes:

  • X-ray helps assess knee osteoarthritis, joint space narrowing, and bone changes.
  • MRI provides a detailed view of joint inflammation, soft tissue damage, and cartilage health.
  • Doppler ultrasound evaluates blood flow and detects abnormal blood vessels in the knee lining.
  • CT angiography (in some cases) maps the blood supply to the knee joint for precise embolization.

Your interventional radiologist will also review your medical history, current medications, and prior treatments, such as knee injections, steroid injections, or physical therapy, to determine if you’re a good candidate for GAE.

Medication & Lifestyle Adjustments

Certain medications and habits may need to be adjusted before the procedure:

  • Blood thinners (such as aspirin or warfarin) may need to be stopped a few days before to reduce the risk of bleeding.
  • Pain medications, including NSAIDs, might be adjusted based on your doctor’s recommendations.
  • Dietary restrictions may apply, so follow specific instructions from your doctor.
  • Hydration is important, so drink plenty of fluids leading up to the procedure unless instructed otherwise.

Pre-Procedure Instructions

On the day of your outpatient procedure, follow these guidelines:

  • Fasting: You may need to avoid eating or drinking for several hours before the procedure. Your doctor will give you specific instructions.
  • What to wear: Choose loose, comfortable clothing to avoid pressure on the puncture site in the groin area.
  • Transportation: Since mild sedation may be used, you’ll need someone to drive you home after the procedure.

Following these steps ensures a safe and successful embolization procedure, helping you get the most out of this non-surgical treatment for chronic knee pain.

What to Expect on the Day of the Genicular Artery Embolization Procedure

Knowing what happens on the day of your genicular artery embolization procedure can help you feel more comfortable and prepared. From check-in to discharge, here’s what you can expect.

Arrival & Pre-Procedure Preparation

When you arrive at the medical facility, you’ll check in and complete any last-minute paperwork. A nurse will take your vitals and start an IV line for sedation and fluids. Unlike knee replacement surgery, GAE doesn’t require general anesthesia.

Instead, you will be given moderate sedation, similar to that used during a colonoscopy or breast biopsy, which helps you stay relaxed while remaining alert and responsive.

Step-by-Step GAE Procedure

Before and after angiogram images showing genicular artery embolization treatment for knee osteoarthritis.

Before and After Genicular Artery Embolization Procedure

During the procedure, an angiogram is performed to pinpoint areas of inflammation. In the area labeled A, hyperemia is visible, which may be contributing to the swelling and pain. The angiogram shows increased blood supply at the site of discomfort. During the Genicular Artery Embolization (GAE) procedure, particles are released via the catheter, targeting the small blood vessels that are causing this discomfort and blocking the blood supply. 

In the after picture, arrow B highlights the same area, where you can observe a clearer view with reduced highlighting. This indicates a reduction in blood flow, confirming the successful embolization of the smaller arteries. The procedure helps to control blood flow, preserving the larger knee artery while shutting down the smaller vessels responsible for the symptoms, ultimately easing persistent knee pain and improving mobility.

  1. Local Anesthesia: The puncture site in your groin area is numbed to prevent discomfort.
  2. Catheter Insertion: A small catheter is inserted into the femoral artery, guided by X-ray imaging.
  3. Angiogram: A contrast dye is injected to highlight abnormal blood vessels in the knee joint.
  4. Embolization: Tiny particles are delivered to block blood flow to inflamed areas in the knee lining, helping to reduce inflammation and provide pain relief.
  5. Procedure Duration: The entire process typically takes one to two hours and is performed without large incisions.

Once the embolization procedure is complete, doctors will monitor you in a recovery room for a short period. Typically patients go home the same day since GAE is an outpatient procedure with no hospital stay required.

Post-Procedure Recovery & Care

Since genicular artery embolization (GAE) is a minimally invasive procedure, most patients go home the same day after spending a few hours in the recovery room. While the procedure doesn’t require large incisions, you may experience mild discomfort at the puncture site in the groin area.

Here’s what to expect after GAE:

  • Mild swelling, bruising, or soreness at the catheter site
  • Avoid strenuous activities for a few days
  • Return to light activity within 24 hours
  • Resume exercise and heavy lifting after one week
  • Pain relief typically begins in 1-2 weeks as inflammation in the knee joint subsides

Your doctor may recommend pain medications, anti-inflammatory medications, or cold therapy to ease any discomfort. A follow-up visit will ensure proper healing and monitor your knee pain relief progress.

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Expected Results and Long-Term Outcomes

Most patients start feeling pain relief within one to two weeks after the genicular artery embolization procedure as joint inflammation decreases. Many report a significant improvement in chronic knee pain, allowing them to return to normal activity without relying on pain medications or frequent knee injections. The effects of GAE can last several years, making it a strong alternative for those who want to avoid knee replacement surgery.

Start Your Path to Pain Relief

Taking the right steps before and after your genicular artery embolization procedure is important for the best results. Following your doctor’s instructions, staying active, and managing joint inflammation properly can help improve your recovery.

At Knee Pain 360, we aim to help individuals find effective solutions for chronic knee pain through innovative, non-surgical treatments like GAE. Our network of experienced interventional radiologists are available nationwide to ensure you receive quality care.

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