Embolization for Knee, Shoulder and Hip Pain: What to Know

By the GSMC pain management team, medically reviewed by Dharam P. Mann, MD

Long-lasting joint pain can shrink your world. Stairs get harder, a night's sleep gets shorter, and walks on the boardwalk turn into short trips. When exercise, physical therapy, medicines and injections have not helped enough, some people ask about a newer, catheter-based option called embolization. This guide explains what it is, who it may help and what to expect.

What is joint embolization?

When a joint is inflamed for a long time, the body can grow extra small blood vessels in the tissue around it. Nerve fibers tend to grow alongside these vessels, and this is linked with pain. Embolization slows that extra blood flow. A very thin tube (catheter) is placed in an artery at the wrist or groin and guided with live X-ray to the small arteries near the painful joint. Tiny particles are then released to reduce the abnormal blood flow.

There is no cut into the joint and nothing is left inside the joint. Embolization does not repair cartilage or tendons. The goal is less pain, so it is easier to move, sleep and stay active.

Knee: genicular artery embolization (GAE)

GAE has been studied more than the shoulder or hip versions. It may help some people with moderate to severe knee osteoarthritis pain that has not improved with other care, including people who want to avoid or delay knee replacement, or who are not candidates for it. Research is still growing, and study results have been mixed. Learn more on our GAE page.

Shoulder: embolization for frozen shoulder

Frozen shoulder (adhesive capsulitis) causes pain and stiffness, often worse at night. For some people whose pain lasts despite therapy and injections, shoulder embolization may ease pain so stretching and therapy become easier. Most published studies are smaller and do not have a comparison group. See our shoulder embolization page.

Hip: an early-stage option

Embolization for hip arthritis and some pain on the outside of the hip is newer still, and research is at an early stage. It may be discussed for people who want to avoid or delay hip replacement, or who are not candidates for it. See our hip embolization page.

What to expect

• Before: We review your exam, X-rays and any MRI, and check kidney function, allergies (including to contrast dye) and medicines such as blood thinners. Do not stop any medicine on your own; we will tell you what to do.
• Getting ready: It is an outpatient procedure. You usually get light sedation, and the skin at the wrist or groin is numbed. Plan for a driver.
• During: A very thin catheter is placed in an artery at the wrist or groin. Using live X-ray and contrast dye, it is guided to the small arteries around the joint, and tiny particles are released. It often takes about 1 to 2 hours.
• After: The catheter is removed and pressure or a closure device is used. After rest and monitoring, most people go home the same day.

Recovery

• Keep the access site clean and dry. Avoid heavy lifting with that arm or leg for a few days.
• Most people return to light activity within a day or two.
• Some soreness in the joint, bruising at the access site, or a short-term skin color change over the joint can happen and usually fades.
• If pain improves, the change often builds over several weeks. Some people notice little or no change.
• Keep up with exercise or physical therapy as advised.

Risks

Every procedure has risks. They include bruising or bleeding at the wrist or groin, a reaction to contrast dye, short-term skin color changes or tenderness over the joint, and, rarely, particles reaching an area that was not intended. Pain may not improve. Our team will go over your specific risks.

Is it covered by insurance?

Coverage for embolization varies. Many insurers consider genicular artery embolization, and embolization for the shoulder or hip, investigational, so it may not be covered. Our team will check your plan and talk with you about costs before anything is scheduled.

Joint pain care at GSMC

Our team sees people with knee, shoulder and hip pain at all 7 GSMC offices in Ocean and Monmouth County: Whiting, Toms River, Brick, Barnegat, Manahawkin, Freehold and West Long Branch. We start with your history, exam and imaging at any of our offices, and explain every option, from physical therapy and injections to nerve-based treatments and embolization. When embolization is a fit, the procedure is done as an outpatient at Manchester Surgery Center in Whiting or Bey Lea Surgery Center in Toms River. If a joint replacement evaluation makes sense, we are glad to coordinate a referral.

Call 732-202-3000 or request a consultation.

Frequently Asked Questions

Where is the procedure done?

Evaluation and workup happen at any of our 7 offices. The procedure is done as an outpatient at Manchester Surgery Center in Whiting or Bey Lea Surgery Center in Toms River.

Is embolization surgery?

No. It is a minimally invasive procedure done through a thin catheter at the wrist or groin, usually with light sedation. Most people go home the same day.

How long does it take to work?

If it helps, the change often builds over several weeks. Results vary, and some people notice little or no change.

Can I still have a joint replacement later?

Yes. Embolization does not rule out a joint replacement or other treatments later.

Is embolization the same as nerve ablation?

No. Radiofrequency ablation uses heat to calm the nerves that carry pain signals. Embolization reduces abnormal blood flow around the joint.

Does insurance cover joint embolization?

Coverage varies, and many insurers consider it investigational. Our team will check your plan before anything is scheduled.

Medical disclaimer: This article is for general education only and is not medical advice. Please talk with your own doctor about your symptoms and treatment. Individual results vary.