Osteoarthritis of the knee poses an ever-expanding healthcare challenge worldwide. Current treatments include conservative methods such as weight loss, pharmacological treatments including NSAIDs, and surgical techniques including total knee arthroplasty. Although frequently successful, contraindications and failure of pharmacological agents leave many, especially with mild-moderate disease, without effective treatment. Genicular artery embolisation is an interventional radiology technique being developed to fill this treatment gap. For this procedure to become established, the literature must provide evidence of its underlying scientific principles, safety, efficacy and economic viability.

Pathological investigation of osteoarthritis reveals that low-level inflammation plays a crucial role in disease development. Joint inflammation stimulates neoangiogenesis and accompanying neuronal growth, with the degree of microvascular invasion being correlated with more severe pain in animal models. These neovessels provide a target for embolisation however, the microscopic effects of this intervention are yet to be elucidated. The side effects of GAE have been extensively investigated with no severe adverse events being recorded. Skin discolouration and puncture site haematoma are the most common, occurring in 10-65% and 0-17% of patients respectively. The literature also discusses ways to minimise these events. Phase one studies provide promising evidence of efficacy, demonstrating an 80% improvement in VAS and a mean difference of 36.8 in WOMAC scores at 24 months. These positive signals are also supported by a single randomised control trial. A single study has been completed regarding the cost of GAE however, further work will be needed before services are commissioned.

The GAE literature demonstrates a safe procedure with promising initial evidence of efficacy. Future work should further elucidate the pathology of osteoarthritis and ways in which embolisation modifies this process, alongside providing further randomised control evidence that aligns with the recommendations from the National Institute for Health and Care Excellence. The future of GAE is exciting!