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Genicular artery embolisation (GAE) London.

A minimally invasive, day case interventional radiology procedure for painful knee osteoarthritis. Selective embolisation of pathological neovessels in the arthritic synovium, aimed at reducing inflammation and pain when injections have failed but you are not ready for knee replacement.

A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

What GAE is

Image guided embolisation of the pathological neovessels in the arthritic knee.

A day case procedure performed by an interventional radiologist through a small nick in the wrist or groin.

Genicular artery embolisation is an interventional radiology procedure. The consultant threads a fine catheter through the radial artery at the wrist, or the common femoral artery at the groin, and guides it up to the six genicular arteries that supply the knee joint. Contrast angiography then shows where the arthritic synovium has grown a network of abnormal new blood vessels, called neovessels, that carry sensory nerve fibres and drive chronic pain.

A microcatheter is advanced into three or four of these branches and 100 to 200 micron microspheres are injected slowly. The particles selectively occlude the abnormal neovessels in the inflamed synovium while preserving the normal blood supply to the bone and skin. Over the following weeks the synovial inflammation settles and pain reduces. GAE does not repair cartilage. It targets the inflammatory, vascular component of knee osteoarthritis.

Who it is for

When GAE is the right step.

Situations where GAE is a reasonable option within the wider set of knee OA treatments.

  • Moderate to severe knee OA

    Kellgren-Lawrence grade 2 or 3 osteoarthritis on weight bearing X-ray with persistent pain.

  • Failed conservative care

    Symptoms unresponsive to physiotherapy, weight loss, analgesia and NSAIDs after a reasonable trial.

  • Failed intra-articular injections

    Little or short lived relief from steroid, hyaluronic acid or PRP injections.

  • Not ready for knee replacement

    Too young, comorbidities, work or family reasons to defer total knee replacement.

  • Wants to defer surgery

    A less invasive step that can buy several years before considering arthroplasty.

  • Suitable vascular anatomy

    Pre-procedure imaging shows accessible genicular arteries with pathological neovessels.

Evidence

What the published data show.

Small to moderate randomised trials, case series and NICE interventional procedures guidance.

Published series and small randomised controlled trials report clinically meaningful pain reduction, with around 60 to 80% of patients reporting a significant improvement in pain and function at 12 to 24 months. Symptom relief typically builds over four to twelve weeks and can be sustained for several years in responders. Longer term follow up beyond three years is still relatively limited but the evidence base is growing steadily, with several ongoing UK and international trials.

NICE has published interventional procedures guidance IPG738 on transcatheter embolisation for painful knee due to osteoarthritis, supporting its use with standard arrangements for clinical governance, consent and audit. GAE is not a cure and it does not reverse cartilage loss. It should be considered as one option within a wider knee OA pathway, alongside conservative care, injections, orthobiologics, genicular nerve procedures and, eventually, joint replacement where needed.

How the procedure works

Around 90 minutes in the IR suite, day case discharge.

Local anaesthetic and light sedation. No general anaesthetic, no incision, no stitches.

  1. 01

    Access

    Radial or common femoral artery puncture under local anaesthetic with light sedation. A small nick, no stitches.

  2. 02

    Angiography

    A catheter is guided to the affected knee and contrast angiography maps the six genicular artery branches supplying the joint.

  3. 03

    Selective microcatheter

    A microcatheter is advanced into three or four branches feeding areas of synovitis, where a hyperaemic blush shows the pathological neovessels.

  4. 04

    Embolisation

    100 to 200 micron microspheres are injected slowly to occlude the abnormal neovessels while preserving normal blood supply to the bone and skin.

  5. 05

    Recovery

    Around 90 minutes total. Radial band or short femoral pressure, two to four hours of observation, then home the same day.

Cost in London

£5,500 to £9,500 all inclusive.

Indicative self pay pricing across the main London interventional radiology units. Insurer covered pathways use the same providers.

In short

GAE in London: £5,500 to £9,500, day case discharge.

The range covers the interventional radiologist, hospital fee, imaging, day case admission, embolic materials and follow up. We share two or three firm quotes once we know your knee X-ray grade and any relevant history.

Where it is performed

London centres offering GAE.

A short list of London units with an interventional radiology suite and consultants performing GAE regularly.

  • HCA London Bridge Hospital

    City centre interventional radiology suite with a busy musculoskeletal embolisation list.

  • HCA The Wellington Hospital

    St John's Wood. Established IR programme covering GAE, PAE and uterine embolisation.

  • Cromwell Hospital (Bupa)

    South Kensington. Bupa flagship with a dedicated IR service and consultant led pathways.

  • University College London Hospitals Private

    Westmoreland Street. Academic IR partnership with published UK GAE experience.

  • Fortius Clinic

    Central London musculoskeletal specialist with GAE offered alongside orthopaedic knee care.

Recovery

What to expect afterwards.

A quick, predictable recovery for most patients. The honest bits are listed here.

  • Walk immediately

    You are up and walking within a few hours of the procedure.

  • Office work in 1 to 3 days

    Most patients return to desk based work within one to three days.

  • Mild access site bruising

    Small bruise at the wrist or groin puncture that settles over a week.

  • Post embolisation soreness

    A transient increase in knee ache or warmth in the first week is common as the neovessels involute.

  • Symptom relief over weeks

    Pain reduction typically builds over four to twelve weeks rather than overnight.

  • Return to sport gradually

    Light exercise from two weeks, structured return to running or racquet sport from six weeks.

Compared to alternatives

GAE vs RFA, orthobiologics and knee replacement.

A short, honest comparison to help you have the right conversation at consultation.

  • Genicular nerve RFA

    A neural block. Radiofrequency ablation of the sensory nerves to the knee. Blocks pain signalling rather than treating inflammation.

  • GAE

    A vascular block. Reduces the abnormal blood supply driving synovial inflammation. Both sit in the knee OA armoury and are sometimes complementary.

  • HA, PRP or BMAC injection

    Orthobiologic and viscosupplementation options aimed at symptom relief and joint environment modulation.

  • Total knee replacement

    The definitive surgical option for end stage OA. GAE is a bridge, not a substitute, when surgery is inevitable.

Related

Related pathways.

Frequently asked

GAE for knee OA, honestly answered.

  • How does GAE relieve knee pain?

    Osteoarthritic knees develop abnormal new blood vessels (neovessels) in the inflamed synovium. These carry sensory nerve fibres and drive pain. GAE uses tiny microspheres to selectively block these abnormal vessels while sparing the healthy blood supply, reducing synovial inflammation and pain.

  • How effective is GAE for knee osteoarthritis?

    Small to moderate randomised trials and case series report around 60 to 80% pain reduction at 12 to 24 months. Longer follow up data are still limited but growing. NICE published interventional procedures guidance IPG738 supporting its use with special arrangements for consent, audit and governance.

  • Is GAE a substitute for knee replacement?

    No. GAE is best thought of as a bridge for patients with moderate OA who are not ready for total knee replacement, or who want to defer it. If your OA is end stage or your knee is mechanically deranged, arthroplasty remains the definitive option.

  • Is GAE painful or risky?

    The procedure itself is done under local anaesthetic and sedation and is well tolerated. Risks are low and include access site bruising, transient skin discolouration over the knee, mild post embolisation soreness and rare non-target embolisation. Serious complications are uncommon in experienced hands.

  • How much does private GAE cost in London?

    Self pay pricing typically runs from £5,500 to £9,500 all inclusive, covering the interventional radiologist, hospital, imaging, day case admission and follow up. We provide two or three firm quotes tailored to your knee and any relevant history.

  • Is GAE covered by private medical insurance?

    Cover varies. Some insurers reimburse GAE for knee OA on a case by case basis with a specialist referral, while others still classify it as investigational.

Speak to a London interventional radiologist

Book GAE in London, with the right consultant.

Insurer preauthorisation handled.