Little-Used Procedures May Relieve Osteoarthritis Pain
These three therapies aim to reduce osteoarthritis pain. But do they work and are they safe?
By Linda Rath | June 11, 2025
People whose osteoarthritis (OA) knee pain isn’t relieved by standard treatments like weight loss, exercise, lifestyle changes and joint injections may have other options. One is a minimally invasive outpatient procedure called genicular artery embolization, or GAE. Although it is FDA-approved for treating hemorrhage and some cancers, GAE is considered experimental for arthritis. Still, it may be a viable choice for some adults over 40 years old who want to avoid or postpone knee replacement or who aren’t good candidates for surgery.
Low-dose radiation (LDR) is another option. This noninvasive treatment has been around for more than 100 years. Although it’s common in Europe, it is rarely used these days in the U.S. But now it’s undergoing something of a revival, and some medical centers offer it to adults over 40. (Cleveland Clinic reserves it for people 65 and older.)
A third option is joint denervation – a procedure that removes nerves that transmit pain signals. It was developed about 30 years ago and is available in some medical centers today. It can be used to relieve nerve pain in joints that are hard to treat, including the fingers, hands and wrists as well as knees.
Here is a closer look at each treatment:
People whose osteoarthritis (OA) knee pain isn’t relieved by standard treatments like weight loss, exercise, lifestyle changes and joint injections may have other options. One is a minimally invasive outpatient procedure called genicular artery embolization, or GAE. Although it is FDA-approved for treating hemorrhage and some cancers, GAE is considered experimental for arthritis. Still, it may be a viable choice for some adults over 40 years old who want to avoid or postpone knee replacement or who aren’t good candidates for surgery.Low-dose radiation (LDR) is another option. This noninvasive treatment has been around for more than 100 years. Although it’s common in Europe, it is rarely used these days in the U.S. But now it’s undergoing something of a revival, and some medical centers offer it to adults over 40. (Cleveland Clinic reserves it for people 65 and older.)
A third option is joint denervation – a procedure that removes nerves that transmit pain signals. It was developed about 30 years ago and is available in some medical centers today. It can be used to relieve nerve pain in joints that are hard to treat, including the fingers, hands and wrists as well as knees.
Here is a closer look at each treatment:
Genicular Artery Embolization
Six arteries supply blood to the knee joint, called genicular arteries. They keep the knee healthy and functioning normally. In OA, the arteries can develop abnormal blood vessels that grow into the bone, causing inflammation, pain and swelling. GAE helps lower inflammation by reducing blood flow in affected parts of the knee. Although no studies have shown that GAE improves joint structure, there is some evidence that it reduces inflammation in the joint lining.
How GAE works
GAE is an outpatient procedure that takes one to two hours under mild sedation. It’s performed by doctors who specialize in nonsurgical procedures using various imaging techniques. In this case, they use an angiogram – an X ray with contrast dye – and often a CT scan to pinpoint the problematic blood vessels. They navigate a spaghetti-thin catheter to the artery and insert tiny beads into it, partially blocking blood flow and helping to reduce pain and improve joint mobility. GAE is highly specific, targeting only abnormal arteries.
What are the results?
There’s not a lot of data on GAE and some study results are conflicting or confusing. One of the largest and most recent meta-analyses (sponsored by a company that produces radiology equipment) looked at nine GAE studies. It found that most patients had significant improvements in knee pain for up to two years and had only minor complications.
In this analysis, about 5% of 270 patients underwent total knee replacement within two years of the GAE and 8% needed a second GAE, but it’s hard to pinpoint exact numbers because of wide differences in the studies that were included.
What are the side effects?
Side effects, including pain, swelling or bruising in the treated knee or where the catheter was inserted, are generally mild and go away within a few weeks to months.
What’s the recovery time?
Recovery times vary, but most people who undergo GAE can resume their normal activities within a few days to a week. This is an advantage over knee replacement, which can take up to a year for a full recovery, is often painful and requires a commitment to physical therapy. Plus, knee replacement isn’t always as successful as people want; about 20% continue to have pain after surgery.
Does insurance cover the cost?
Insurance usually pays for some portion of GAE when it’s used to treat hematomas or cancer. But because there’s so little evidence about its safety and effectiveness for knee pain, private insurers are unlikely to foot the bill. Medicare may cover it in certain circumstances with prior authorization, but it’s best to check with Medicare about your specific case.
Depending on where you live, out-of-pocket costs for GAE may run around $3,000 – half the price of hyaluronic acid injections, but far more than nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. Still, long-term use of NSAIDs can have side effects including stomach ulcers, bleeding and heart problems, so they can end up costing far more than GAE or injections.
How GAE works
GAE is an outpatient procedure that takes one to two hours under mild sedation. It’s performed by doctors who specialize in nonsurgical procedures using various imaging techniques. In this case, they use an angiogram – an X ray with contrast dye – and often a CT scan to pinpoint the problematic blood vessels. They navigate a spaghetti-thin catheter to the artery and insert tiny beads into it, partially blocking blood flow and helping to reduce pain and improve joint mobility. GAE is highly specific, targeting only abnormal arteries.
What are the results?
There’s not a lot of data on GAE and some study results are conflicting or confusing. One of the largest and most recent meta-analyses (sponsored by a company that produces radiology equipment) looked at nine GAE studies. It found that most patients had significant improvements in knee pain for up to two years and had only minor complications.
In this analysis, about 5% of 270 patients underwent total knee replacement within two years of the GAE and 8% needed a second GAE, but it’s hard to pinpoint exact numbers because of wide differences in the studies that were included.
What are the side effects?
Side effects, including pain, swelling or bruising in the treated knee or where the catheter was inserted, are generally mild and go away within a few weeks to months.
What’s the recovery time?
Recovery times vary, but most people who undergo GAE can resume their normal activities within a few days to a week. This is an advantage over knee replacement, which can take up to a year for a full recovery, is often painful and requires a commitment to physical therapy. Plus, knee replacement isn’t always as successful as people want; about 20% continue to have pain after surgery.
Does insurance cover the cost?
Insurance usually pays for some portion of GAE when it’s used to treat hematomas or cancer. But because there’s so little evidence about its safety and effectiveness for knee pain, private insurers are unlikely to foot the bill. Medicare may cover it in certain circumstances with prior authorization, but it’s best to check with Medicare about your specific case.
Depending on where you live, out-of-pocket costs for GAE may run around $3,000 – half the price of hyaluronic acid injections, but far more than nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. Still, long-term use of NSAIDs can have side effects including stomach ulcers, bleeding and heart problems, so they can end up costing far more than GAE or injections.
Low-Dose Radiation (LDR)
This noninvasive treatment uses X-rays to reduce inflammation in painful joints, including the knees, hips, hands, shoulders, ankles and elbows. It was widely used in the U.S. for arthritis pain until the 1980s, when inexpensive NSAIDs hit the market. Today, fewer than 10% of U.S. health care providers use LDR for OA-related pain, whereas 85% in Germany do. However, some medical centers, including Cleveland Clinic, Loyola Medicine in Chicago and UCLA Health are reviving the use of this treatment.
How LDR works
LDR targets inflamed areas of the joint with very low doses of radiation. This reduces inflammation and improves mobility. Patients usually receive six radiation treatments over two or three weeks. Each session takes about 10 minutes. One reason LDR fell out of favor was concern about radiation, which can cause cancer in higher doses. But the doses used for arthritis pain are very low – three units of radiation compared to 40 or 50 units to treat breast cancer and 70 to 80 units for prostate cancer. In Germany, where the procedure has been widely used for decades, there have been no reported cases of LDR-related cancer.
What are the results?
Study results of LDR are mixed, with some patients showing no improvement. Part of the confusion is due to differences in the studies. In general, though, most research suggests that LDR reduces pain and improves mobility for about 75% of people who receive it. Some get relief almost right away. Plus, the benefits seem long-lasting, potentially preventing the need for future joint replacement. The treatments can also be repeated, if needed.
What are the side effects?
Side effects from treatment are minimal; about one in 1,000 people develop skin redness at the radiation site, but there is no down time.
Does insurance cover the cost?
Medicare and private insurers usually cover the treatment as long as radiation oncologists bill properly and don’t use bells-and-whistles technology. Still, check with your insurer first.
How LDR works
LDR targets inflamed areas of the joint with very low doses of radiation. This reduces inflammation and improves mobility. Patients usually receive six radiation treatments over two or three weeks. Each session takes about 10 minutes. One reason LDR fell out of favor was concern about radiation, which can cause cancer in higher doses. But the doses used for arthritis pain are very low – three units of radiation compared to 40 or 50 units to treat breast cancer and 70 to 80 units for prostate cancer. In Germany, where the procedure has been widely used for decades, there have been no reported cases of LDR-related cancer.
What are the results?
Study results of LDR are mixed, with some patients showing no improvement. Part of the confusion is due to differences in the studies. In general, though, most research suggests that LDR reduces pain and improves mobility for about 75% of people who receive it. Some get relief almost right away. Plus, the benefits seem long-lasting, potentially preventing the need for future joint replacement. The treatments can also be repeated, if needed.
What are the side effects?
Side effects from treatment are minimal; about one in 1,000 people develop skin redness at the radiation site, but there is no down time.
Does insurance cover the cost?
Medicare and private insurers usually cover the treatment as long as radiation oncologists bill properly and don’t use bells-and-whistles technology. Still, check with your insurer first.
Joint Denervation
This minimally invasive surgical treatment tackles chronic joint pain by removing the nerves that send pain signals to the brain. Surrounding healthy tissue and other nerves are left intact, so movement isn’t affected and may even improve as pain gets better.
How it works
How denervation is performed depends on the joint, but it is almost always an outpatient procedure using small incisions and lasting less than two hours.
In knee denervation, the surgeon makes a small cut on either side of the knee and uses a tiny camera to locate the four nerves that relay pain. These are severed and reattached to nearby muscles, where they begin to function like motor nerves. The brain then rewires to adapt to the switch. The procedure takes about 45 minutes and usually requires only local anesthesia or a nerve block. There is no special postoperative care, and patients can resume their normal activities in a week or two.
What are the results?
Study results are somewhat mixed over the long term. In one small safety study of 21 patients with knee OA, pain scores decreased from 8.7 to 2.9, and mobility improved significantly for at least two years. Another study of 50 patients treated for ongoing pain after total knee replacement found that most showed great improvement in pain and mobility for at least two years. But the authors of a meta-analysis of six trials found that although joint denervation significantly improved pain and function initially, the benefits lasted only a few months. Nerves regrow, so if you’re considering this procedure, be sure to ask your surgeon how long your results might last.
What are the side effects?
Potential risks include:
It’s unlikely that most insurers will cover this procedure; check with your insurance carrier.
How it works
How denervation is performed depends on the joint, but it is almost always an outpatient procedure using small incisions and lasting less than two hours.
In knee denervation, the surgeon makes a small cut on either side of the knee and uses a tiny camera to locate the four nerves that relay pain. These are severed and reattached to nearby muscles, where they begin to function like motor nerves. The brain then rewires to adapt to the switch. The procedure takes about 45 minutes and usually requires only local anesthesia or a nerve block. There is no special postoperative care, and patients can resume their normal activities in a week or two.
What are the results?
Study results are somewhat mixed over the long term. In one small safety study of 21 patients with knee OA, pain scores decreased from 8.7 to 2.9, and mobility improved significantly for at least two years. Another study of 50 patients treated for ongoing pain after total knee replacement found that most showed great improvement in pain and mobility for at least two years. But the authors of a meta-analysis of six trials found that although joint denervation significantly improved pain and function initially, the benefits lasted only a few months. Nerves regrow, so if you’re considering this procedure, be sure to ask your surgeon how long your results might last.
What are the side effects?
Potential risks include:
- Swelling, bruising or temporary numbness around the treated area
- Infection at the incision sites
- Ineffective pain relief or, in rare cases, increased pain
It’s unlikely that most insurers will cover this procedure; check with your insurance carrier.
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