Dr. Flechenstein

Dr. med. Florian Nima Fleckenstein, MD
Board Certified Radiologist | Specialist Interventional Radiology | BIH Clinician Scientist
Deputy Head of IR Campus Mitte
Coordinator IASIOS Accreditation
Department of Radiology
Berlin Institute of Health (BIH)
Charité – Universitätsmedizin Berlin

PainRelief.com: What is the background for this study? What are the main findings?

Response: Knee osteoarthritis, the most common form of knee arthritis, is a leading cause of chronic pain and loss of mobility worldwide. Many patients reach the point where painkillers, physical therapy and joint injections no longer bring enough relief, but knee replacement surgery still feels too early or just isn’t the right path for them. For this very large group, there have been few good options so far.

Genicular artery embolization, or GAE for short, is a minimally invasive, non-surgical procedure designed for exactly this situation. Through a very small puncture in the groin, we guide tiny catheters to the small arteries that feed the inflamed areas of the knee and block them. Reducing this abnormal blood flow calms the inflammation that drives osteoarthritis pain.

In our study, published in the journal Radiology, 194 patients were treated and followed for a full year. The results were very encouraging. On a scale from 0 to 10, average pain fell from 7 before treatment to 3 after one year. Between 55 and 80 percent of patients reported meaningful improvements not only in pain, but also in daily activities, sports and quality of life. Side effects were mild and short-lived in about 7 percent of cases, usually just some temporary skin discoloration. No serious complications occurred.

PainRelief.com: What should readers and patients take away from your study?

Response: If you are living with ongoing knee osteoarthritis pain, have exhausted the usual conservative options and are not ready or willing to undergo knee replacement, genicular artery embolization can be a safe and effective alternative. It is a short and largely pain-free procedure, and our data show meaningful, lasting knee pain relief and better joint function for at least one year.

What matters just as much as the procedure itself is where and how it is done. GAE works best when it is part of a multidisciplinary pathway. In our center, every candidate is discussed jointly with orthopedic surgery before treatment, and this careful selection is in my view the single most important factor behind the good outcomes we see. Patients considering GAE should look for a center that works this way.

PainRelief.com: What are the next steps for musculoskeletal embolization?

Response: The most important next step is to make GAE more widely available and more consistently part of standard treatment plans for knee osteoarthritis. For many patients today, there is a wide gap between conservative therapy and knee replacement surgery, and GAE belongs in that space.

Beyond the knee, the same principle of embolization can address abnormal blood flow and inflammation in other joints and tendons as well. At Charité – Universitätsmedizin Berlin, we are already applying this approach to osteoarthritis of the shoulder, hip and other joints, to frozen shoulder (adhesive capsulitis), and to sports and overuse injuries such as Achilles tendinopathy, often called Achilles tendonitis. Our department’s patient page on embolization for chronic joint and tendon pain offers more details (in German).

We also want to learn how long the relief lasts beyond the first year, and whether treating earlier in the course of the disease can delay or even prevent the need for knee replacement.

PainRelief.com: If a friend with knee pain asked you whether genicular artery embolization might be right for them, what would you say?

Response: As with every patient, I would be clear about what GAE can and cannot do. It does not rebuild worn cartilage, but no other treatment can either. GAE can calm the inflammation behind the pain and thereby treat the pain itself. In our study, pain had already dropped noticeably at the first check-up after six weeks, and that improvement held for the full year. And because the best decisions are made together, I would encourage my friend to talk it through with both an orthopedic surgeon who knows about this procedure and an interventional radiologist.

PainRelief.com: If you had to describe GAE in three words, what would they be?

Response: Swift. Safe. Effective. Swift, because the procedure using temporary particles is quick and relief often sets in within the first days. Safe, because in nearly 200 patients we saw only mild, temporary side effects and no serious complications. And effective, because most patients in our study had clearly less pain, and that improvement lasted the full year.

PainRelief.com: Thank you Dr. Fleckenstein.

For more on the study, see the press release from the RSNA (Radiological Society of North America).

For a broader overview of knee osteoarthritis treatment, see this PainRelief.com overview of physical therapy vs steroid injection for knee osteoarthritis.

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Last Updated on November 3, 2026 by PainRelief.com