(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
- Osteoarthritis continues to progress
- Injections help calm inflammation or lubricate the join, ut they cannot stop cartilage loss.
- As knee OA worsens:
- Inflammation inside the joint becomes chronic
- Bone spurs may form
- Nerves around the joint become hypersensitive
- Eventually, injections don’t provide enough benefit
- Steroid injections have diminishing returns
- Steroids reduce inflammation, but:
- The effect becomes shorter over time
- Steroids can weaken cartilage if used too frequently
- Guidelines limit them to 3-4 injections per year
- So for may patients, pain relief slowly fades.
- Steroids reduce inflammation, but:
- Gel injections don’t work well in advanced OA
- Hyaluronic acid injections act like lubrication, but in sever arthritis, the join is to damaged for them to be helpful.
- Studies show they work best in mild-moderate OA, not bone on bone disease.
- Pain may not be coming only from the joint
- OA affects the entire knee system:
- 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
- Altman RD, et al. “Recommendations for the Use or Intra-Articular Therapies in the Management of Osteoarthritis.” Osteoarthritis and Cartilage. 2015.
- Bagla S, et al. “Genicular Artery Embolization for the Treatment of Knee Pain Secondary to Osteoarthritis.” Journal of Vascular and Interventional Radiology. 2020.
- Little MW, et at. “Genicular Artery Embolization for Osteoarthritis-Related Knee Pain: Clinical Results.” Cardiovascular and Interventional Radiology. 2021.
- American College of Rheumatology. “Guidelines for Management of Osteoarthritis of the Knee.” 2019.
