{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T08:52:54Z","timestamp":1785919974564,"version":"3.56.0"},"reference-count":36,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T00:00:00Z","timestamp":1785628800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006256","name":"Universit\u00e0 degli studi dell'Aquila","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006256","id-type":"DOI","asserted-by":"publisher"}]},{"id":[{"id":"https:\/\/ror.org\/01j9p1r26","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Genicular Artery Embolization (GAE) is an emerging minimally invasive procedure for the treatment of pain due to knee osteoarthritis (OA) in patients who are not candidates for joint replacement surgery. The aim of this study is to evaluate the clinical and functional outcomes of GAE performed with a temporary embolic agent and the persistence of its benefits up to 6 months of follow-up. Methods: In this prospective study, 15 consecutive patients (mean age 64.5 \u00b1 6.7 years) with Kellgren\u2013Lawrence grade III\u2013IV knee OA, severe pain refractory to conservative treatments, and not eligible for joint replacement surgery were enrolled. All patients underwent GAE with selective embolization of hypervascular genicular branches using an imipenem\/cilastatin suspension as a temporary embolic agent. Patients were evaluated before the procedure, on the first postoperative day, and at 3 and 6 months of follow-up using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Oxford Knee Score (OKS), and the Visual Analog Scale (VAS). Results: All clinical scores showed a significant improvement over time (p &lt; 0.05). WOMAC decreased from 55.6 \u00b1 7.3 to 16.3 \u00b1 4.1 at 6 months; KOOS increased from 40.7 \u00b1 8.1 to 70.3 \u00b1 6.4; OKS improved from 18.4 \u00b1 4.2 to 38.9 \u00b1 4.6; VAS decreased from 7.8 \u00b1 1.0 to 1.5 \u00b1 0.8. No major complications were observed. Two patients (13.3%) developed a subcutaneous hematoma at the femoral access site, which resolved spontaneously. In two patients, pain recurred at the 1-month follow-up. Conclusions: GAE with a temporary embolic agent appeared to be a safe and effective procedure in improving pain and function in patients with advanced knee OA who are not candidates for joint replacement surgery. The clinical benefit was progressive and sustained up to 6 months, supporting the role of synovitis modulation as a therapeutic target.<\/jats:p>","DOI":"10.3390\/jcm15156014","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T11:50:21Z","timestamp":1785757821000},"page":"6014","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Genicular Artery Embolization (GAE) for the Treatment of Advanced Knee Osteoarthritis in Selected Nonoperative Patients: A Pilot Study at 6 Months Follow-Up"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7766-0806","authenticated-orcid":false,"given":"Andrea","family":"Fidanza","sequence":"first","affiliation":[{"name":"Unit of Orthopaedics, Department of Life Health & Environmental Sciences, University of L\u2019Aquila, 67100 L\u2019Aquila, AQ, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6986-6001","authenticated-orcid":false,"given":"Aurelio","family":"Picchi","sequence":"additional","affiliation":[{"name":"Unit of Orthopaedics, Department of Life Health & Environmental Sciences, University of L\u2019Aquila, 67100 L\u2019Aquila, AQ, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Ciaglia","sequence":"additional","affiliation":[{"name":"Unit of Diagnostic and Interventional Radiology, SS Filippo e Nicola Hospital, 67051 Avezzano, AQ, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmine","family":"Timpani","sequence":"additional","affiliation":[{"name":"Unit of Diagnostic and Interventional Radiology, SS Filippo e Nicola Hospital, 67051 Avezzano, AQ, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Zugaro","sequence":"additional","affiliation":[{"name":"Unit of Diagnostic and Interventional Radiology, SS Filippo e Nicola Hospital, 67051 Avezzano, AQ, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7618-6732","authenticated-orcid":false,"given":"Gianfilippo","family":"Caggiari","sequence":"additional","affiliation":[{"name":"Orthopaedic Department, Sassari University Hospital, 07100 Sassari, SS, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giandomenico","family":"Logroscino","sequence":"additional","affiliation":[{"name":"Unit of Orthopaedics, Department of Life Health & Environmental Sciences, University of L\u2019Aquila, 67100 L\u2019Aquila, AQ, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"963","DOI":"10.2106\/00004623-200405000-00012","article-title":"Health-Related Quality of Life in Total Hip and Total Knee Arthroplasty. A Qualitative and Systematic Review of the Literature","volume":"86","author":"Ethgen","year":"2004","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Kaspiris, A., Hadjimichael, A.C., Lianou, I., Iliopoulos, I.D., Ntourantonis, D., Melissaridou, D., Savvidou, O.D., Papadimitriou, E., and Chronopoulos, E. (2023). Subchondral Bone Cyst Development in Osteoarthritis: From Pathophysiology to Bone Microarchitecture Changes and Clinical Implementations. J. Clin. Med., 12.","DOI":"10.3390\/jcm12030815"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1080\/03008207.2018.1470167","article-title":"Conditioned media from human osteoarthritic synovium induces inflammation in a synoviocyte cell line","volume":"60","author":"Belluzzi","year":"2019","journal-title":"Connect. Tissue Res."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Berteau, J.P. (2022). Knee Pain from Osteoarthritis: Pathogenesis, Risk Factors, and Recent Evidence on Physical Therapy Interventions. J. Clin. Med., 11.","DOI":"10.3390\/jcm11123252"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Osuala, U., Goh, M.H., Mansur, A., Smirniotopoulos, J.B., Scott, A., Vassell, C., Yousefi, B., Jain, N.K., Sag, A.A., and Lax, A. (2024). Minimally Invasive Therapies for Knee Osteoarthritis. J. Pers. Med., 14.","DOI":"10.3390\/jpm14090970"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Thirumaran, A.J., Deveza, L.A., Atukorala, I., and Hunter, D.J. (2023). Assessment of Pain in Osteoarthritis of the Knee. J. Pers. Med., 13.","DOI":"10.3390\/jpm13071139"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Femia, M., Valenti Pittino, C., Fumarola, E.M., Tramarin, M., Papa, M., Giurazza, F., Francioso, A.P., Fior, D., Moramarco, L.P., and Antonini, G. (2024). Genicular Artery Embolization: A New Tool for the Management of Refractory Osteoarthritis-Related Knee Pain. J. Pers. Med., 14.","DOI":"10.3390\/jpm14070686"},{"key":"ref_8","first-page":"592","article-title":"Embolization of genicular arteries in patients with knee osteoarthritis as an alternative for refractory pain treatment: A systematic review","volume":"159","year":"2022","journal-title":"Med. Clin."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1093\/rheumatology\/keh344","article-title":"Osteoarthritis, Angiogenesis and Inflammation","volume":"44","author":"Bonnet","year":"2005","journal-title":"Rheumatol. Oxf. Engl."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2700","DOI":"10.1002\/art.30422","article-title":"Contributions of Angiogenesis to Inflammation, Joint Damage, and Pain in a Rat Model of Osteoarthritis","volume":"63","author":"Ashraf","year":"2011","journal-title":"Arthritis Rheum."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1423","DOI":"10.1136\/ard.2006.063354","article-title":"Neurovascular Invasion at the Osteochondral Junction and in Osteophytes in Osteoarthritis","volume":"66","author":"Suri","year":"2007","journal-title":"Ann. Rheum. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1346","DOI":"10.1002\/art.21015","article-title":"Linking Angiogenesis to Bone Destruction in Arthritis","volume":"52","author":"Pap","year":"2005","journal-title":"Arthritis Rheum."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1007\/s00270-023-03422-0","article-title":"Genicular Artery Embolization as a Treatment for Osteoarthritis Related Knee Pain: A Systematic Review and Meta-Analysis","volume":"46","author":"Epelboym","year":"2023","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"23259671211021356","DOI":"10.1177\/23259671211021356","article-title":"Osteoarthritis-Related Knee Pain Treated With Genicular Artery Embolization: A Systematic Review and Meta-Analysis","volume":"9","author":"Torkian","year":"2021","journal-title":"Orthop. J. Sports Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2043","DOI":"10.1016\/j.jvir.2020.08.012","article-title":"The Value of Preprocedural MR Imaging in Genicular Artery Embolization for Patients with Osteoarthritic Knee Pain","volume":"31","author":"Choi","year":"2020","journal-title":"J. Vasc. Interv. Radiol. JVIR"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1530","DOI":"10.1007\/s00270-019-02289-4","article-title":"Clinical Outcomes of Transcatheter Arterial Embolisation for Chronic Knee Pain: Mild-to-Moderate Versus Severe Knee Osteoarthritis","volume":"42","author":"Lee","year":"2019","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1016\/j.jvir.2017.02.033","article-title":"Midterm Clinical Outcomes and MR Imaging Changes after Transcatheter Arterial Embolization as a Treatment for Mild to Moderate Radiographic Knee Osteoarthritis Resistant to Conservative Treatment","volume":"28","author":"Okuno","year":"2017","journal-title":"J. Vasc. Interv. Radiol. JVIR"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.jvir.2021.09.019","article-title":"Multicenter Randomized Sham Controlled Study of Genicular Artery Embolization for Knee Pain Secondary to Osteoarthritis","volume":"33","author":"Bagla","year":"2022","journal-title":"J. Vasc. Interv. Radiol. JVIR"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1007\/s00270-020-02764-3","article-title":"Genicular artEry embolizatioN in patiEnts with oSteoarthrItiS of the Knee (GENESIS) Using Permanent Microspheres: Interim Analysis","volume":"44","author":"Little","year":"2021","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e21.00085","DOI":"10.2106\/JBJS.OA.21.00085","article-title":"Genicular Artery Embolization for the Treatment of Symptomatic Knee Osteoarthritis","volume":"6","author":"Padia","year":"2021","journal-title":"JBJS Open Access"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.knee.2022.12.008","article-title":"Two-Year Outcomes Comparing Embosphere\u00ae Microspheres versus Imipenem Cilastatin for Genicular Artery Embolization in Patients with Moderate to Severe Knee Osteoarthritis","volume":"41","author":"Bhatia","year":"2023","journal-title":"Knee"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1580","DOI":"10.1016\/j.arth.2014.03.031","article-title":"Poor WOMAC scores in contralateral knee negatively impact TKA outcomes: Data from the osteoarthritis initiative","volume":"29","author":"Kahn","year":"2014","journal-title":"J. Arthroplast."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Hamdan, M., Haddad, B.I., Isleem, U., Yasin, M., Alrabayah, M., Al Hawamdeh, H., Almasaid, S., Jibrin, D., Daas, M., and AlRyalat, S.A. (2022). The Effect of a Single Intravenous Corticosteroid Administration on Pain after Knee Arthroscopy: A Prospective, Double-Blind, Non-Randomized Controlled Clinical Trial. J. Clin. Med., 12.","DOI":"10.3390\/jcm12010197"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Cinelli, V., Marescalchi, M., Picchi, A., De Mattia, G., Andriollo, L., Fidanza, A., Logroscino, G., Sangaletti, R., Benazzo, F., and Rossi, S.M.P. (2025). Total Knee Arthroplasty and the Evolution of Coronal Alignment: From Mechanical to Personalized Strategies. J. Pers. Med., 15.","DOI":"10.3390\/jpm15110524"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1016\/j.jvir.2023.02.028","article-title":"Short-Term Effects of Genicular Artery Embolization on Symptoms and Bone Marrow Abnormalities in Patients with Refractory Knee Osteoarthritis","volume":"34","author":"Wang","year":"2023","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1716","DOI":"10.1007\/s00270-025-04145-0","article-title":"Genicular Artery Embolization Using an Ethiodized Oil-Based Emulsion in Fifty Knees: 12-Month Results","volume":"48","author":"Sapoval","year":"2025","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.knee.2022.03.013","article-title":"Transcatheter Arterial Embolization of Abnormal Neovessels in a Swine Model of Knee Arthritis","volume":"36","author":"Kamisako","year":"2022","journal-title":"Knee"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2309","DOI":"10.1007\/s00256-022-04208-0","article-title":"Genicular Artery Embolization as a Treatment for Refractory Osteoarthritis Related Knee Pain","volume":"52","author":"Epelboym","year":"2023","journal-title":"Skelet. Radiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1007\/s00270-025-04188-3","article-title":"Genicular Artery Embolization for Symptomatic Knee Osteoarthritis: A Comprehensive Review of Techniques and Clinical Outcomes","volume":"48","author":"Ahmed","year":"2025","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1699","DOI":"10.1007\/s00270-021-02948-5","article-title":"Current Status of Trans-Arterial Embolization in Pain Management of Musculoskeletal Inflammatory Conditions\u2014An Evidence-Based Review","volume":"44","author":"Riis","year":"2021","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1771","DOI":"10.1007\/s00270-025-04243-z","article-title":"Imipenem\/Cilastatin in Embolization: From Antibiotic to Therapeutic Agent","volume":"48","author":"Rouzbahani","year":"2025","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1599","DOI":"10.1136\/ard.2006.067470","article-title":"Synovitis Detected on Magnetic Resonance Imaging and Its Relation to Pain and Cartilage Loss in Knee Osteoarthritis","volume":"66","author":"Hill","year":"2007","journal-title":"Ann. Rheum. Dis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1016\/j.joca.2023.06.005","article-title":"Fundamentals of Osteoarthritis: Inflammatory Mediators in Osteoarthritis","volume":"31","author":"Monteagudo","year":"2023","journal-title":"Osteoarthr. Cartil."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2157","DOI":"10.1093\/rheumatology\/ker283","article-title":"What Makes Osteoarthritis Painful? The Evidence for Local and Central Pain Processing","volume":"50","author":"Sofat","year":"2011","journal-title":"Rheumatol. Oxf. Engl."},{"key":"ref_35","first-page":"75","article-title":"Structural Correlates of Pain in Osteoarthritis","volume":"35","author":"Neogi","year":"2017","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1038\/nrrheum.2012.80","article-title":"Mechanisms and Targets of Angiogenesis and Nerve Growth in Osteoarthritis","volume":"8","author":"Mapp","year":"2012","journal-title":"Nat. Rev. Rheumatol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/15\/6014\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T08:41:53Z","timestamp":1785919313000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/15\/6014"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,2]]},"references-count":36,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15156014"],"URL":"https:\/\/doi.org\/10.3390\/jcm15156014","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,2]]}}}