Knee Osteoarthritis: Alternatives to Knee Replacement

Quick answer

For painful knee osteoarthritis, knee replacement remains effective but is not always wanted straight away. Genicular artery embolization and genicular nerve radiofrequency ablation are minimally invasive options to delay or complement surgical management.

Replacement is not always the only option

For painful knee osteoarthritis (gonarthrosis), total knee replacement remains an effective and proven solution, but it is not always wanted or indicated immediately, particularly in young patients, those who wish to postpone surgery, or those with contraindications.

First-line medical treatments

Painkillers, anti-inflammatory drugs, physiotherapy and injections (corticosteroids or hyaluronic acid) make up the first line of treatment. Their effect is, however, most often transient when osteoarthritis is accompanied by chronic synovial inflammation.

Minimally invasive interventional radiology techniques

When medical treatments are no longer sufficient, two complementary techniques can be offered at Cochin AP-HP: genicular artery embolization, which targets the abnormal vessels responsible for chronic synovial inflammation, and genicular nerve radiofrequency ablation, which interrupts the transmission of the pain signal.

Frequently asked questions

Do these techniques replace knee replacement?

No, they do not replace knee replacement when it is clearly indicated, but they can delay it or improve comfort while waiting for an operation.

How do I know which technique is right for me?

An imaging work-up and a dedicated consultation determine whether you are a candidate for embolization, radiofrequency ablation, or both.

Learn more

Knee osteoarthritis centre at Cochin AP-HP

Genicular artery embolization, genicular nerve radiofrequency ablation, block test: the complete pathway.

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New in the literature: 2026 review of musculoskeletal embolization

A narrative review published in October 2026 in CVIR Endovascular (Pelage JP, Aldalmani T, Geevarghese R, Zhang N, Jegonday MA, Berry G, Dohan A, Fohlen A, Grange S) sorts the indications of musculoskeletal arterial embolization by level of evidence. Hemostatic and selected tumour-related indications are established. Pain-directed embolization, including genicular artery embolization and embolization for tendinopathies, is performed as a stand-alone minimally invasive procedure targeting pathological neovascularity. Evidence remains heterogeneous: the authors stress careful patient selection, standardized outcome assessment and further comparative trials to define durability and clinical value. It covers genicular artery embolization for knee osteoarthritis, the subject of this page.

Read the review (DOI) → · View on PubMed →

Why this page is trustworthy

Written by the Interventional Radiology team at Cochin Hospital AP-HP, Université Paris Cité. Medically reviewed by an interventional radiologist of the department. Last updated: August 2026.

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Knee osteoarthritis: alternatives to knee replacement