Inside access

Bertoni H, Viso R, et al. Genicular Artery Embolization for Persistent Pain after Total Knee Arthroplasty: Initial Clinical Experience. JVIR, 2025;37.

Tell us about you, your team and your institution.

Hernán G. Bertoni, MD: We are a multidisciplinary team composed of interventional radiologists, interventional cardiologists and a surgeon, working together to provide a comprehensive approach to embolotherapy, endovascular treatments and oncologic interventions. We practice at Fundación Fleni in Buenos Aires, a leading institution primarily dedicated to the care of patients with neurological diseases. We have also developed a growing program in cardiovascular interventions and embolotherapy within a collaborative, patient-centered environment.

Why did you pursue this topic?

Dr. Bertoni: This topic arose from the need to bring greater visibility to a minimally invasive and effective therapeutic option for patients with chronic pain after total knee arthroplasty. Many of these patients remain significantly limited in their daily lives and depend on long-term analgesic use, often with suboptimal results. We were motivated to explore and highlight an alternative that could meaningfully improve pain, restore function and reduce the burden of chronic medication use.

What are the key takeaways from your research?

Dr. Bertoni: Our findings suggest that genicular artery embolization (GAE) represents a valid therapeutic option for carefully selected patients with chronic, refractory pain after total knee arthroplasty (TKA). In this context, GAE may provide meaningful pain relief and functional improvement, particularly in patients without identifiable mechanical causes of symptoms. These results support its role as a minimally invasive alternative within the multidisciplinary management of post-TKA pain.

How might this research influence treatment, practice, or clinical processes in interventional radiology?

Dr. Bertoni: This technique opens a highly promising and engaging field within the daily practice of interventional radiology. If these results are confirmed over the mid- and long-term, and with broader adoption and coverage by healthcare systems, genicular artery embolization could become an important component of musculoskeletal care. Given the global burden of osteoarthritis, this may also lead to the development of more specialized expertise within interventional radiology focused on osteoarticular embolization.

What motivated your team to investigate genicular artery embolization (GAE) for patients with chronic pain after total knee arthroplasty?

Dr. Bertoni: This study was primarily driven by our orthopedic surgery colleagues, who are part of our multidisciplinary GAE team. Based on their initial clinical observations and early results, they encouraged us to further investigate the role of GAE in patients with chronic pain after total knee arthroplasty, particularly in those with limited therapeutic alternatives.

What changes did patients experience in terms of pain relief and function after undergoing GAE?

Dr. Bertoni: Patients experienced a meaningful improvement in both pain and knee function following GAE. This was supported by statistically significant reductions in WOMAC pain and function scores, as detailed in our study. These findings reflect a consistent clinical benefit in a population with limited therapeutic options.

What do you see as the main clinical implications of GAE for managing post-TKA pain, and are there particular patients who might benefit most?

Dr. Bertoni: Pain relief is the primary goal of this technique. Patients with chronic post-TKA pain often experience significant limitations in their daily lives, including impaired sleep, depressive symptoms and long-term analgesic use, all of which negatively impact their quality of life. In this context, GAE may offer meaningful clinical benefit.

Patients who are most likely to benefit are those with persistent pain in the absence of significant mechanical limitation. When substantial mechanical dysfunction is present, GAE alone is unlikely to be sufficient to restore function or provide adequate pain control, highlighting the importance of careful patient selection.

Any next steps or plans for follow-up research?

Dr. Bertoni: Our next steps include continued multidisciplinary follow-up with orthopedic surgeons at predefined intervals, emphasizing annual assessment. We will evaluate long-term outcomes of GAE, focusing on durability, sustained clinical benefit and its role within standardized treatment algorithms.