Minimally Invasive Treatment for Knee Pain and Osteoarthritis (GAE)

In the morning it takes a few minutes before the knee “warms up”. Stairs have become a chore, walks are getting shorter, and at night the pain sometimes wakes you. You have tried painkillers, physiotherapy, maybe injections, and the relief was partial or short-lived. Then comes the sentence many patients know well: “It’s cartilage wear, eventually you’ll need a knee replacement.”

Chronic knee pain caused by cartilage wear (osteoarthritis) can significantly limit mobility and reduce quality of life. It often leads to difficulty walking, climbing stairs and performing daily activities. Between the point where conservative treatments stop working and joint replacement surgery there is a large gap. The Society of Interventional Radiology (SIR) has described exactly this gap, and presents genicular artery embolization as a targeted, joint-preserving procedure that addresses the inflammatory component of knee pain [6].

This page covers what you need to know about genicular artery embolization (GAE): who it suits and who it does not, how the process works, what happens on the day, recovery, risks, what the research shows, including the findings that are still debated, and how it compares with knee replacement.

Genicular Artery Embolization (GAE) is a minimally invasive treatment designed to reduce pain and improve function in patients with knee osteoarthritis. The procedure works by decreasing inflammation through targeted catheter-based therapy, without surgery and with relatively short downtime.

In osteoarthritic knees, increased inflammation is often associated with the formation of small abnormal blood vessels (neovascularization) around painful tissues. Pain-carrying nerve fibers tend to grow alongside these vessels. During GAE, these abnormal vessels are selectively and carefully blocked using tiny particles under advanced imaging guidance. The goal is to reduce blood flow to inflamed tissue, decrease pain and swelling, and improve joint function.

It helps to be clear about what GAE does and does not do: it does not rebuild cartilage or change the structure of the joint. It aims to relieve pain and inflammation while keeping your own knee.

GAE may be suitable for patients who:

• Suffer from chronic knee pain due to osteoarthritis (OA)
• Have tried conservative treatments (physical therapy, medications, injections) without sufficient relief
• Wish to delay or avoid knee replacement surgery
• Are not ideal surgical candidates due to medical conditions or personal preference

Who tends to benefit more

Most studies have focused on mild to moderate osteoarthritis. According to a review published by the Society of Interventional Radiology, patients with severe osteoarthritis did not respond as well, because at the late stage pain is driven more by structural damage than by inflammation. The same review notes that focal pain that can be reproduced on examination is associated with better outcomes, and that when there is significant meniscal or ligament damage at the same time, the improvement may be less pronounced [7].

When GAE is less suitable

• Pain that comes mainly from a mechanical problem, such as a locked meniscal tear or instability
• Very advanced osteoarthritis with marked joint deformity
• Active infection of the knee or an undiagnosed systemic inflammatory disease
• Severe arterial disease in the leg, significant kidney impairment or a contrast allergy

Final eligibility is determined after a consultation, including imaging (X-ray and/or MRI) and evaluation of the severity and source of pain. For more on the condition and its diagnosis, see Knee pain from osteoarthritis: non-surgical treatment options.

Step 1: Consultation in Modiin

Private consultations take place at the Elite Medical clinic in Modiin on Mondays. Dr. Farkas goes over the history of your pain, the treatments you have already tried and your imaging, examines the knee and explains whether a catheter-based treatment suits your condition. Please bring a referral letter, knee X-rays and MRI if available, blood tests and notes from your orthopedist or physiotherapist. An initial video consultation can also be arranged.

Step 2: Evaluation and planning

Before the procedure your medical history and imaging are reviewed, blood tests are done as needed, and further imaging is sometimes ordered. If you take blood thinners, you will be told whether and when to pause them.

Step 3: Scheduling

The procedure itself is performed in the angiography suite at Shaare Zedek Medical Center in Jerusalem. Our office explains the coverage options and books the date, and you receive exact instructions beforehand.

Anesthesia

GAE is done under local anesthesia, with sedation as needed. General anesthesia is not required.

The procedure, step by step

1. A tiny entry point: a thin catheter is inserted through a small puncture, usually in the groin or wrist, into the blood vessels that lead to the knee.
2. Mapping: contrast is injected to identify the small vessels feeding the painful areas. You may be asked whether your familiar pain appears during the injection, which helps with targeting.
3. Targeted embolization: tiny particles are injected into selected vessels to reduce inflammation.
4. Recovery and discharge: GAE is typically performed on an outpatient basis, with short observation afterward. No overnight stay is needed.

Does it hurt?

This is the most common worry before a catheter procedure. Discomfort is minimal, and it is reduced with local anesthesia and sedation. All that remains is a small puncture mark, which in most cases is barely visible.

• The first days: most patients return to light daily activity within a short time. Mild pain, swelling or local discomfort may occur and is usually temporary. According to the SIR review, some patients have increased knee stiffness lasting 24 to 48 hours [7].
• The first week: mild knee soreness or swelling typically resolves within about a week.
• Weeks to months: improvement in pain and function typically occurs gradually, depending on the condition and individual response. The same review notes that patients usually report improvement within a few weeks, and sometimes within the first week [7].

Continuing physiotherapy and muscle strengthening after GAE is recommended. A less painful knee makes it easier to exercise, and exercise supports the result over time.

As with any minimally invasive procedure, there are potential risks, generally rare:

• Temporary pain and knee stiffness
• Bruising at the puncture site
• Temporary skin discoloration over the knee
• Reaction to contrast material
• Infection
• Unintended blockage of small blood vessels
• Rarely, a temporary change in sensation in the sole of the foot [7]

No serious adverse events were reported in the controlled trials. In a randomized trial from the Netherlands there were 23 mild adverse events in the treatment group and 5 in the sham group, with no serious events [2]. In a follow-up study of 25 patients, no severe adverse events occurred [4]. During your consultation, we will carefully review the risks versus benefits based on your specific medical condition.

In Dr. Farkas’s clinical experience, the success rate is between 70 and 90 percent in carefully selected patients. We also want to give you the full picture of the published research, which is still developing:

• Sham-controlled trial (USA): in a multicenter study of 21 patients randomized to GAE or a sham procedure, pain reduction at one month was significantly greater in the treatment group, and only minor adverse events were reported [1].
• One-year follow-up study: in a study of 25 patients, 62% met the definition of clinical success at 12 months, and the average pain score fell by about 55% [4].
• Sham-controlled trial (Netherlands): in a study of 58 patients with mild to moderate osteoarthritis, both the GAE group and the sham group reported a similar reduction in pain at 4 months [2], and at 12 months there was still no significant difference between the groups [3].
• Systematic review: a review of three sham-controlled trials (138 patients) concluded that GAE appears safe and may provide short-term relief in selected patients, but that larger, longer studies are needed before firm conclusions can be drawn [5].

What does this mean for you? GAE is considered safe, and some patients get meaningful relief, though not everyone does. That is why careful patient selection matters most, and at your consultation Dr. Farkas will tell you openly what your chances are. Larger trials are under way. For more detail, see the GAE patient guide for knee pain and osteoarthritis.

GAE does not replace knee replacement surgery, but it may delay or reduce the need for surgery in patients with mild to moderate osteoarthritis. Knee replacement is an effective operation for advanced osteoarthritis, and in some situations it is the right choice.

This comparison is general and does not replace a consultation. A decision about knee replacement is made together with an orthopedic surgeon. Having GAE does not close the door on surgery later if it is needed.

Treatment for knee osteoarthritis is usually stepwise. First come weight loss where needed, physiotherapy and strengthening, and pain or anti-inflammatory medication. Next, injections into the joint, which give some patients relief for a period. When all of these are no longer enough and pain keeps limiting daily life, the question becomes what to do next.

This is where GAE comes in. It is aimed mainly at patients in the middle ground: the pain is significant and conservative options have been exhausted, but the knee has not reached the point where joint replacement is the clear recommendation, or the patient cannot or does not want to have surgery. The goal is to relieve pain, make it possible to move and exercise again, and delay the need for surgery for as long as possible.

• How advanced is the wear in my knee, and does my pain look inflammatory or mechanical?
• Is there a meniscal or ligament tear that could affect the result?
• What are my chances of benefit, and what happens if relief is only partial?
• Can both knees be treated, and in what order?
• When can I get back to walking, driving and physiotherapy?
• How does GAE affect the option of knee replacement later, if I need it?

Suitability is decided at a consultation, after reviewing your imaging and test results. Please bring all your medical records. If your hip hurts as well, read about minimally invasive treatment for chronic hip pain, or learn more about Dr. Adam Farkas.

This page provides general information and does not replace personal medical advice. Results vary from patient to patient.

Where is the consultation and where is the procedure?

Private consultations are held at the Elite Medical clinic in Modiin on Monday afternoons. The procedure itself takes place in the angiography suite at Shaare Zedek Medical Center in Jerusalem. To book, see our contact page.

1. Bagla S, et al. Multicenter Randomized Sham Controlled Study of Genicular Artery Embolization for Knee Pain Secondary to Osteoarthritis. Journal of Vascular and Interventional Radiology (SIR). 2022. doi.org/10.1016/j.jvir.2021.09.019
2. van Zadelhoff TA, et al. Genicular artery embolisation versus sham embolisation for symptomatic osteoarthritis of the knee: a randomised controlled trial. BMJ Open. 2024;14(10):e087047. doi.org/10.1136/bmjopen-2024-087047
3. van Zadelhoff TA, et al. Long-term outcomes of genicular artery embolization for knee osteoarthritis: 12-month efficacy and secondary outcomes from a randomized sham-controlled clinical trial. European Radiology. 2026. doi.org/10.1007/s00330-026-12505-8
4. Taslakian B, et al. A Prospective Single-Arm Trial of Genicular Artery Embolization for Symptomatic Knee Osteoarthritis: Clinical and Biomarker Outcomes. Journal of Vascular and Interventional Radiology (SIR). 2025. doi.org/10.1016/j.jvir.2025.08.009
5. Milhem F, et al. Genicular artery embolization for knee osteoarthritis: A systematic review of sham-controlled randomized trials. Journal of Orthopaedics. 2025. doi.org/10.1016/j.jor.2025.07.022
6. Ahmed O, et al. Society of Interventional Radiology Position Statement on Genicular Artery Embolization for Symptomatic Knee Osteoarthritis. Journal of Vascular and Interventional Radiology (SIR). 2026. doi.org/10.1016/j.jvir.2026.108803
7. Society of Interventional Radiology, IR Quarterly. Genicular artery embolization (Bagla S). 2022. sirweb.org