Genicular artery embolization (GAE) cuts intra-articular steroid injections by more than half in patients with knee osteoarthritis, according to a study published October 14 in the Journal of Vascular and Interventional Radiology. 

The findings suggest that GAE could help fill a gap in care for knee osteoarthritis patients who have exhausted injections but are not candidates for or would prefer to avoid surgery, noted lead author Aryaman Singh, a medical student at the University of Virginia in Charlottesville, and colleagues. 

"Steroid injections provide only short-term relief, and repeated use carries concern for further cartilage damage, while the benefit of hyaluronic acid remains contentious," the group wrote. 

Symptomatic knee osteoarthritis affects an estimated 14 million U.S. adults, the authors wrote. GAE is an emerging interventional radiology technique that targets the inflamed joint lining the knee that drives osteoarthritis pain by embolizing the genicular arteries that supply it, they explained. Despite growing use of GAE for knee osteoarthritis, its effect on downstream injection patterns in real-world clinical practice had not been characterized, the authors noted. 

To bridge the gap, the researchers conducted a retrospective cohort analysis of a Medicare databases from 2014 through 2024. Patients were identified by CPT code 37242 paired with a knee osteoarthritis diagnosis within seven days. Annualized steroid and total intra-articular injection use were compared for the 12 months before and six months after the procedure. 

According to the results, among 126 patients who met the study’s enrollment criteria (mean age, 64.2 years old; 57.9% female), mean annualized steroid injection use fell from 0.96 injections to 0.48 per patient-year (-50.4%; p = 0.004), and any intra-articular injection use fell from 2.88 injections to 1.60 per patient-year (-44.4%; P

"This pattern suggests that GAE may provide pain relief while limiting cumulative steroid exposure," the authors wrote. 

However, the researchers noted, the decrease is also consistent with the treatment pathway itself. Patients referred for GAE have often had unsatisfactory relief from injections and may not resume them regardless of how the procedure performs, leaving a before-and-after comparison within the same patients vulnerable to confounding by indication.

Nonetheless, in the present cohort, nearly one third of patients continued to receive steroid injections after GAE, indicating that injections remained available and in use, they wrote. 

"Prospective comparative studies with longer follow-up and standardized clinical outcomes are needed to determine whether GAE reduces the need for injections," the researchers concluded. 

The full study is available here.