GAE- a novel minimally invasive way to treat knee OA pain

Aneurin Bevan University Health Board

Dr Nimit Goyal, Consultant Interventional Radiologist

Dr Rebecca Wallace, Research Lead for Radiology

Mr Andrew Miller, Consultant Orthopaedic Surgeon

Osteoarthritis (OA) is considered a condition of MSK pain with approximately 450,000 individuals living with OA in Wales (Versus Arthritis OA Calculator). Mild to moderate knee OA, not yet severe enough to warrant joint replacement, and resistant to nonsurgical options, represents a specific management challenge.

Current treatment options include physiotherapy and drug interventions. The pathogenesis of OA appears to be multi-faceted, with angiogenesis borne out of inflammatory processes theorised to play a significant role in the OA-associated pain. Geniculate artery embolization (GAE) is an Interventional Radiology procedure that aims to relieve pain related to OA by embolising the pathological new vessels while maintaining the larger vascular supply to the bone. It is done as a day case using local anaesthesia. A catheter is passed in the femoral artery and then angiography is performed to identify the blood vessels supplying the area of increased vascularity. Once the abnormal new vessels are identified, a microcatheter is navigated into them under X-ray guidance. Tiny embolization particles are then delivered to the area of increased vascularity until the blood flow is stopped. GAE is the focused embolization the pathological neovessels, with preservation of the genicular artery.

This project looks to explore the effectiveness of this novel interventional radiological procedure, genicular artery embolization, as a treatment option to reduce pain and improve joint mobility and overall quality of life and wellbeing in those patients living with mild- moderate osteoarthritis of the knee. As the first known study in Wales to investigate the potential benefits of this embolization procedure, it is hoped this study will realise the benefits of this intervention and lead ultimately to widespread adoption within Wales.