Genicular artery embolisation (GAE)

GAE is a treatment for knee pain, most commonly caused by osteoarthritis. An interventional radiologist uses X-ray guidance (fluoroscopy) to pass a thin catheter into the arteries that supply the lining of the knee.

They then block off the abnormal small blood vessels (neovascularisation) that drive inflammation and pain. There is no cutting and no surgery on the knee joint itself.

GAE targets pain and inflammation rather than replacing the joint, so it may suit people who:

• have knee pain that hasn't improved with physiotherapy, medication or injections
• have mild to moderate osteoarthritis
• aren't suitable for a knee replacement, or would like to avoid or delay one

Whether it's right for you depends on an assessment by an orthopaedic surgeon.

• It's done in a cath lab (a specialised X-ray theatre), under conscious sedation or local anaesthetic.
• The radiologist uses needles, catheters and image guidance rather than surgical cuts.
• It takes place in the morning, and most patients go home the same day.

Currently, we are only able to perform this treatment in Cape Town. Unfortunately we cannot provide this treatment if you are living elsewhere in South Africa.

No. It's important to be clear about what GAE can and can't do. A total knee replacement is a definitive operation that replaces the damaged joint, and for advanced (bone-on-bone) arthritis it remains the most durable option.

GAE doesn't replace the joint. It's best thought of as a pain-reduction procedure that may delay the need for surgery, particularly for people with mild to moderate arthritis, or those who aren't ready for, aren't suitable for, or wish to avoid surgery.

We recommend asking your orthopaedic surgeon about all of your options.

GAE is supported by a growing body of evidence, including a randomised sham-controlled trial.^1,2 As with any treatment, results vary from person to person.

Because knee pain has many causes and every case is different, it's hard to predict exactly how much relief any one person will get, or how long it will last. Talking through realistic expectations is a big part of the GP consultation.

The total cost can amount to R200 000. This covers the radiologist, the anaesthetist, the hospital admission, use of the cath lab and medical consumables.

Because of this, we recommend funding the procedure through your medical aid. We won't go ahead until you know what the cost to you will be.

We submit a pre-authorisation application to your medical aid on your behalf to find out whether they'll cover it, and provide any extra motivation letters needed.

These procedures aren't always readily funded, so we often have to motivate for them. To support this, you'll need a referral letter from an orthopaedic surgeon recommending the treatment.

We recommend Dr Marc Nortjé at Cape Hip and Knee. You can contact them directly, or book a telephonic consultation with the CTIR GP, who can write a referral for you.

A 20-minute information session by phone with the general practitioner for CTIR. We'll explain:

• how the procedure works
• its pros and cons, and the evidence behind it
• what you can realistically expect from it

We can also help with a referral letter to the orthopaedic surgeon. The consultation costs R275, paid upfront. Book a consultation.

1. An orthopaedic surgeon assesses you to see whether you're a candidate.
2. They send a referral letter to CTIR.
3. We submit a pre-authorisation application to your medical aid.
4. Once it's approved, we book a date for the procedure.
5. The procedure takes place at Mediclinic Constantiaberg or UCT Private Academic Hospital, in the morning, and you go home the same day.
6. After the procedure, you'll be referred to a physiotherapist. As your knee pain eases, it becomes easier to exercise, and a guided programme to strengthen the muscles around the knee and improve movement can help you get the most out of the treatment and make the benefit last longer.
7. We follow up with you within 6 weeks, and your orthopaedic surgeon arranges their own follow-up.