The evolution of therapy for chronic osteoarthritic knee pain: Feasibility, safety and clinical outcomes of transpedal access for genicular artery embolization

OBJECTIVE: To assess the feasibility, safety, and clinical outcomes of genicular artery embolization (GAE) via transpedal approach for the treatment of knee pain secondary to chronic knee osteoarthritis (OA). MATERIALS AND METHODS: This single-center, prospective quality improvement (QI) initiative measured clinical outcomes and patient experience of 69 patients (110 knees) who underwent genicular artery embolization between August 2024 and May 2025. The project was conducted in accordance with institutional quality improvement policies, and all patients provided informed consent for the procedure. Patients had chronic knee osteoarthritis with Kellgren-Lawrence (KL) grade ≥ 2. Pain and mobility were assessed using Visual Analog Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline and at 1, 3, and 6 months. Minimal clinically important difference (MCID) thresholds were defined as a ≥ 2-point VAS reduction or ≥ 20-point WOMAC improvement. Adverse events were classified by Society of Interventional Radiology (SIR) standards. RESULTS: Sixty-nine patients (110 knees; mean age 72.6 ± 7.43 years, 62% female, mean BMI 33.48 ± 7.78) underwent GAE. Kellgren Lawrence (KL) distribution was 51.82% grade 3 and 24.55% grade 4. Transpedal access was successful in 97.3%, and technical success was achieved in 100% of cases. Mean procedure time was 30.24 ± 16.24 min, fluoroscopy time 10.17 ± 6.25 min, and contrast volume 87.59 ± 25.6 mL. No access site complications occurred. Three patients (2.7%) had self-limiting adverse reactions. VAS decreased from 8.05 ± 1.77 at baseline to 4.78, 4.25, and 4.25 at 1, 3, and 6 months; WOMAC decreased from 72.9 ± 16.3 at baseline and at 42.55, 38.58, and 40.99 at respective timepoints (p < 0.05). At the patient level, 50/69 patients (72.5%) achieved VAS MCID and 49/69 patients (71.0%) achieved WOMAC MCID during follow-up. CONCLUSION: Transpedal GAE was feasible, safe, and associated with clinically meaningful improvements in pain and function through six months in this single-center cohort. These findings support further study of transpedal access as an alternative approach for GAE. Larger-scale multicenter comparative studies are warranted.