Cynthia Schraf-Fletcher thought she might need major surgery to escape chronic knee pain. Instead, a 90-minute outpatient procedure has delivered results nearly identical to the total knee replacement she'd had on her other knee.
"I couldn't be more pleased," the 74-year-old says of genicular artery embolization, or GAE, a technique that blocks blood flow to inflamed areas inside the joint. Within a year, she went from struggling with basic activities to gardening and riding a stationary bike without the debilitating pain that had plagued her.
GAE addresses a gap that has long frustrated both patients and doctors. Between conservative treatments like injections and physical therapy on one end and total knee replacement on the other, there has been almost nothing for people seeking relief from chronic knee pain who weren't ready for major surgery.
"GAE is a promising minimally invasive procedure that may fill that spot for people who have failed conservative treatments but are not yet ready to have a major surgery," says Leigh Casadaban, an assistant professor of radiology at the University of Colorado Anschutz School of Medicine and a vascular interventional radiologist.
How It Works
The procedure works by reducing blood flow to abnormal vessels associated with inflammation in the knee joint. A team makes a small incision near the leg crease and advances a tiny catheter through the femoral artery using X-ray guidance and contrast dye.
Once positioned at the genicular arteries around the knee, doctors release microscopic beads that block blood flow to the problematic vessels. The entire procedure typically lasts one to two hours under conscious sedation.
Patients go home the same day after a few hours of monitoring. Recovery involves taking it easy for a few days afterward.
Originally developed in Japan over a decade ago, GAE has gained steady traction worldwide. Since 2021, the FDA has granted breakthrough device status to multiple GAE-related devices in the United States.
According to Casadaban, roughly 70 percent of patients experience dramatic results. "They cut their pain scores in half, sometimes more. We have a few patients with no pain at all after the procedure," he says.
The treatment works best for people with mild to moderate osteoarthritis, though those with more advanced disease can also undergo it, though the effects tend to be less durable.
Pain Relief That Lasts Years
Research suggests the benefits stick around. Four-year data from Japan shows that a single outpatient procedure can deliver pain relief lasting that entire span. In the United States, two-year follow-up data demonstrates similar durability for patients who respond well to treatment.
"The theory is that GAE reduces inflammation inside the knee joint, and symptom relief can last years," Casadaban explains. "That really speaks to the theory that we're hopefully modifying something in the joint."
Casadaban is currently leading two clinical trials at CU Anschutz exploring GAE further. One examines changes in knee fluid among treated patients. The other evaluates a temporary arterial treatment device called Nexsphere-F, which blocks small blood vessels that may contribute to inflammation and pain.
While GAE is currently limited to knee conditions, researchers and physicians are beginning to explore whether the technique could help with other painful musculoskeletal disorders, including frozen shoulder, tennis elbow, and plantar fasciitis.
Author Jessica Williams: "This is exactly the kind of treatment that fills a real need, and the data backing it up is solid enough to take seriously."
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