If you’re living with chronic knee pain from osteoarthritis in Maryland or Virginia, you’ve probably heard that knee replacement surgery is the “gold standard.” And for many patients, it is a reliable, well-studied option. But it’s not the only option—and for a growing number of patients, it may not be the best first step.
Genicular artery embolization (GAE) is a minimally invasive, non-surgical procedure that treats knee osteoarthritis pain by targeting the abnormal blood vessels that fuel inflammation inside the joint. It’s performed as an outpatient procedure, requires no general anesthesia, and allows most patients to return to daily activities within days rather than months.
At Surgical Associates (SACMD), Dr. Albert Chun has been performing GAE for patients across Maryland, DC, and Northern Virginia who want real pain relief without the risks, recovery time, or lifestyle disruption of a total knee replacement. In this article, we’ll walk through what the clinical evidence actually shows, compare the two procedures side by side, and explain who may benefit most from each.
What the Clinical Evidence Says About GAE
GAE is no longer a theoretical treatment. Multiple prospective clinical trials, including sham-controlled randomized studies, have now been published, validating its safety and efficacy.
The Bagla Sham-Controlled RCT (JVIR, 2022). This multicenter, single-blinded, randomized controlled trial enrolled 21 patients with mild-to-moderate knee osteoarthritis and intractable pain. Patients were randomized 2:1 to receive either GAE or a sham procedure. At one month, the GAE group showed a significant reduction in VAS pain scores compared to sham (−50.8 vs. −0.5), confirming that the treatment effect goes beyond placebo. The study was conducted under an FDA Investigational Device Exemption and registered on ClinicalTrials.gov (NCT03362957).
The NYU Prospective Trial (JVIR/ScienceDirect, 2025). This prospective, single-arm trial of 25 patients treated with 250-μm permanent microspheres demonstrated a 55.4% reduction in VAS pain scores at 12 months (P < .001). WOMAC pain scores improved by 43.7% at the same time point, and the clinical success rate—defined as a clinically meaningful improvement on the WOMAC pain subscale—was 62%. The study also found statistically significant decreases in serum VEGF (vascular endothelial growth factor) and IL-1Ra, suggesting that GAE may reduce the inflammatory and angiogenic drivers of osteoarthritis pain at a biological level, not just symptomatically.
The UCLA 2-Year IDE Trial (JVIR, 2024). Among 40 patients with moderate-to-severe knee OA, 67.5% achieved clinical success at 12 months. Of those initial responders, 72% maintained their improvement at 24 months. No new treatment-related adverse events occurred after the first year, confirming a favorable long-term safety profile.
Meta-Analysis (2023). A systematic review and meta-analysis of 9 studies (270 patients, 339 knees) found that GAE produced statistically significant and clinically meaningful reductions in both VAS and WOMAC scores at every follow-up interval through 12 months. The technical success rate across all studies was 99.7%. Over two years of follow-up, only 5.2% of patients went on to require total knee replacement, and adverse events were typically minor and transient—most commonly temporary skin discoloration (11.6%).
A Note on Mixed Evidence
It’s important to acknowledge that not every trial has found a statistically significant difference between GAE and sham. A 2024 RCT from Rotterdam (58 patients, 4-month follow-up) did not establish a clear clinical effect of GAE over sham in patients with mild-to-moderate knee OA when using permanent microspheres. The investigators noted, however, that their embolization protocol evolved during the study—starting with single-vessel treatment before transitioning to multi-vessel embolization—which may have affected outcomes.
The systematic review of all three sham-controlled RCTs (138 total patients, published 2025) concluded that GAE demonstrated short-term pain reduction, particularly at one month, but that longer follow-up and larger studies are needed to confirm durability. This is an active and evolving field of research.
GAE vs. Knee Replacement: A Side-by-Side Comparison
| Factor | GAE | Total Knee Replacement |
|---|---|---|
| Procedure type | Minimally invasive (catheter-based, through a small wrist or groin puncture) | Major surgery (8–12 inch incision, bone and cartilage removal, prosthetic implant) |
| Anesthesia | Local anesthesia with light sedation | General or spinal anesthesia |
| Procedure time | 1–2 hours | 1–3 hours |
| Hospital stay | Outpatient (same-day discharge) | 1–4 days inpatient |
| Return to daily activities | 1–3 days | 4–6 weeks (often longer) |
| Return to full function | 1–2 weeks | 3–6 months of physical therapy |
| Pain after procedure | Mild soreness for a few days | Significant post-operative pain requiring prescription pain management for weeks |
| Incision | Tiny puncture (no stitches needed) | 8–12 inch surgical incision |
| Joint preservation | Yes—no tissue, bone, or cartilage removed | No—native joint is permanently removed and replaced |
| Implant lifespan | N/A (no implant) | 15–25 years; may require revision surgery |
| Repeat treatment | Can be repeated if needed; does not prevent future surgery | Revision surgery is more complex and has higher complication rates |
| Major risks | Temporary skin discoloration (~12%); rare focal skin ulcer (<1%) | Infection (1–2%), blood clots, stiffness, implant loosening, nerve damage |
| Best candidates | Mild-to-moderate OA; failed conservative therapy; not yet surgical candidates; want to delay or avoid surgery | Severe OA with bone-on-bone damage; significant structural joint destruction |
Who Is a Candidate for GAE?
GAE works best for patients who fall into a treatment gap: conservative approaches (physical therapy, anti-inflammatory medications, steroid injections) are no longer providing adequate relief, but knee replacement surgery feels premature, too risky, or simply undesirable.
Strong GAE candidates typically include patients who have mild-to-moderate osteoarthritis (Kellgren-Lawrence grade 2–3) with persistent pain despite conservative management, patients who are younger or more active and want to preserve their native joint as long as possible, patients with medical conditions that increase the risks of major surgery, and patients who simply prefer a non-surgical approach with minimal downtime.
GAE After Knee Replacement: A Finding Worth Knowing
One of the most compelling emerging applications of GAE is its use for patients who still have pain after a knee replacement. Persistent pain after total knee arthroplasty (TKA) is more common than most patients expect—up to 20% of knee replacement patients report ongoing pain that doesn’t resolve with the surgery.
A pilot study published in 2023 enrolled 12 patients with persistent pain after TKA who had no evidence of prosthetic loosening, infection, or mechanical failure. After GAE using 75-μm particles, the mean VAS pain score on walking improved from 73 at baseline to 38 at six months (P < .05), and 73% of patients attained a clinically important change in quality of life. A more recent 2025 study of 15 post-arthroplasty patients showed significant pain reduction at one month (median NRS dropping from 7.0 to 1.0, P < .001), with improvements sustained through 12 months.
This is significant: if you’ve already had knee replacement surgery and are still struggling with pain, GAE may offer relief where further surgery cannot. Dr. Albert Chun at Surgical Associates evaluates post-TKA pain patients on a case-by-case basis to determine whether GAE may help.
Why Patients in Maryland and Virginia Are Choosing GAE at Surgical Associates
The DMV area has no shortage of orthopedic surgeons, but very few practices offer GAE as a treatment option for knee osteoarthritis. Surgical Associates is among the few in the region providing this procedure, led by Dr. Albert Chun, a board-certified interventional radiologist with over 18 years of experience and training from George Washington University Medical School and Harvard Medical School/Brigham and Women’s Hospital.
Patients can be seen at Surgical Associates’ Camp Springs, Waldorf, Silver Spring (Maryland), Washington DC, or Reston (Virginia) locations for an evaluation. GAE is increasingly covered by insurance, including Medicare, when performed as a medically necessary procedure for refractory knee OA pain.
The Bottom Line
Knee replacement surgery remains an excellent option for patients with severe, end-stage osteoarthritis. But for the millions of patients whose knee pain falls somewhere between “manageable with Advil” and “needs a new joint,” GAE represents a meaningful step forward—one backed by a growing body of randomized, controlled, and prospective evidence.
If you’re in Maryland, DC, or Northern Virginia and want to explore whether GAE could help you delay or avoid knee replacement surgery, we encourage you to schedule a consultation with Dr. Chun at Surgical Associates. No referral is required.
Schedule a consultation: Call (240) 427-1630 or visit www.sacmd.com
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Individual results vary. Consult with a qualified physician to determine whether GAE or knee replacement is appropriate for your condition.
References:
- Bagla S, Piechowiak R, Sajan A, et al. Multicenter Randomized Sham-Controlled Study of Genicular Artery Embolization for Knee Pain Secondary to Osteoarthritis. J Vasc Interv Radiol. 2022;33(1):2-10.
- Taslakian B, Mabud T, Attur M, et al. A Prospective Single-Arm Trial of Genicular Artery Embolization for Symptomatic Knee Osteoarthritis: Clinical and Biomarker Outcomes. J Vasc Interv Radiol. 2025.
- Cusumano LR, Sparks HD, Masterson KE, et al. Genicular Artery Embolization for Treatment of Symptomatic Knee Osteoarthritis: 2-Year Outcomes from a Prospective IDE Trial. J Vasc Interv Radiol. 2024;35(12):1768-1775.
- Genicular artery embolization for treatment of knee osteoarthritis pain: Systematic review and meta-analysis. 2023.
- Little MW, et al. Genicular Artery Embolisation in Patients with Osteoarthritis of the Knee (GENESIS) Using Permanent Microspheres: Long-Term Results. Cardiovasc Intervent Radiol. 2024.
- Effectiveness of Geniculate Artery Embolization for Chronic Pain after Total Knee Replacement—A Pilot Study. 2023.
- Gornik HL, Aronow HD, Goodney PP, et al. 2024 ACC/AHA/Multisociety Guideline for the Management of Lower Extremity Peripheral Artery Disease. J Am Coll Cardiol. 2024;83(24):2497-2604.
Dr. Rahbar is an esteemed vascular surgeon at Surgical Associates, known for their exceptional contributions to the field of vascular surgery. As a board-certified vascular surgeon with over 20 years of invaluable experience, Dr. Rahbar is a respected authority in the medical community serving Camp Spring, Maryland and the whole community of Maryland. Their unwavering dedication to providing advanced care for patients with diseases of the arteries and veins has earned them a reputation for excellence. Dr. Rahbar’s work embodies a passion for precision and compassion, improving the lives of those they serve, one procedure at a time.