What is GAE?

Why an arthritic knee hurts

Osteoarthritis is a disease of use. Over many years, the protective cartilage capping the ends of the bones wears away, and the unprotected bone surfaces begin to rub against each other. That produces pain, stiffness and weakness, and because the process is progressive, it tends to worsen rather than plateau. It can affect any joint, and it is often at its most disabling in the knee.

There is a second half to the story that gets much less attention. The synovium — the lining of the joint — becomes inflamed, and inflamed synovium releases chemical signals that damage cartilage further. More cartilage damage produces more inflammation. It is a self-sustaining loop, and a great deal of the pain patients feel comes from the inflammation rather than from the bare bone itself.

That inflamed lining also does something distinctive: it grows an abnormally rich blood supply to sustain itself. And a blood supply is something that can be treated.

What GAE does

Genicular artery embolization blocks the excess blood flow feeding the lining of the knee. Less blood to the inflamed tissue means less inflammation, and less inflammation means less pain.

GAE does not repair the cartilage damage that caused the arthritis in the first place — no procedure currently does. What it can do is significantly reduce pain and slow some of the degenerative processes driven by chronic inflammation. Published studies have reported that patients treated with GAE describe average pain scores falling from around eight out of ten to around three, which is a substantial change in the daily experience of living with an arthritic knee.

What the procedure involves

Our physicians perform GAE as an outpatient procedure that usually takes about an hour. Twilight sedation is used, so you are sleepy and calm but breathing on your own — there is no general anesthesia.

The physician inserts a catheter, a thin hollow tube, into an artery at the upper thigh. Using X-ray images, the catheter is guided along the artery supplying blood to the lining of the knee. Once it is in position, tiny gel particles are injected to restrict the amount of blood flowing into that inflamed tissue.

Patients go home the same day. There is no incision to heal and nothing is left inside the knee. Reduced pain is usually noticeable after about two weeks, as the inflammation in the joint settles down, and improvement typically continues over the following months.

Is GAE the right treatment for me?

GAE is an excellent non-surgical option for people with advanced knee osteoarthritis who have run out of good alternatives short of replacement.

Early in osteoarthritis, anti-inflammatory medication and physical therapy usually ease symptoms well. Over time they become less effective. Steroid or hyaluronic acid injections often help when conservative treatment starts to fall short. When those in turn stop working, and you are either not ready for surgery or not a good candidate for it, GAE fills the gap.

The best candidates are generally between forty and eighty years old, with moderate to severe knee pain and without gross bony deformity in the joint. Importantly, GAE closes no doors: if you eventually need a knee replacement, having had GAE does not prevent it.

Call 1Vascular to find out whether GAE can reduce your osteoarthritis pain.