What knee osteoarthritis does to your joints

Knee osteoarthritis (OA) is one of the most common causes of chronic knee pain, especially in older adults. It develops when the smooth cartilage that cushions the ends of the bones begins to break down. Over time, the joint becomes inflamed, painful, and less flexible. OA can occur without a specific cause (primary osteoarthritis) or as a result of injury, abnormal joint stress, or inflammatory disease (secondary osteoarthritis).

As the condition progresses, pain and stiffness gradually increase, limiting day-to-day movement and independence. Some people notice mild discomfort at first, which can evolve into more persistent pain that flares after activity or long periods of sitting. The rate of progression varies from person to person, but without intervention, OA can significantly affect mobility and quality of life.

Cartilage degeneration

In a healthy knee, the articular cartilage provides a smooth, gliding surface that allows pain-free movement. In osteoarthritis, this cartilage begins to deteriorate in stages:

Early stage: The cartilage starts to lose its structure as water content increases and collagen fibers weaken. Small cracks may appear, and cartilage cells (chondrocytes) work harder to repair the damage.

Progressive stage: Over time, the repair process can no longer keep up. The cartilage softens and thins, and enzymes that break down tissue become more active. This imbalance leads to faster deterioration.

Advanced stage: Eventually, the cartilage may wear away completely. Bones begin to rub directly against each other, causing severe pain, stiffness, and the formation of bone spurs that restrict joint movement.

Inflammation

Osteoarthritis is not just a “wear and tear” problem. Low-grade, persistent inflammation plays a major role in its progression.

Synovial irritation: The inner lining of the joint, called the synovium, becomes inflamed in a process known as synovitis. This inflammation is triggered by fragments of damaged cartilage and bone within the joint space.

Immune response: The body reacts to these fragments as if they were foreign particles. Immune cells release inflammatory chemicals (cytokines) that further damage the cartilage and sustain inflammation.

Chronic pain: As the cycle continues, the inflamed joint tissues become more sensitive to pain. This inflammation is one of the main reasons OA pain becomes constant rather than occasional.

Increased blood vessel formation (Angiogenesis)

A lesser-known but important feature of osteoarthritis is angiogenesis, or the formation of new, abnormal blood vessels in and around the joint. These fragile new vessels often invade areas that normally lack blood supply, like the cartilage and bone interface. They bring with them new nerve fibers, making the joint more sensitive to pain. This process contributes directly to chronic pain and is the main therapeutic target of Genicular Artery Embolization (GAE).

GAE works by blocking these abnormal vessels, which reduces both inflammation and nerve-related pain. This helps break the cycle of discomfort while preserving healthy blood flow in the surrounding tissue.

Treatment usually begins with lifestyle adjustments, physiotherapy, and medications. However, when these no longer bring relief, newer minimally invasive procedures like Genicular Artery Embolization (GAE) may help manage pain and inflammation effectively.

As osteoarthritis advances, the combination of cartilage loss, chronic inflammation, and excessive blood vessel growth makes pain more difficult to control with standard treatments. Understanding these underlying changes helps explain why procedures like GAE can provide meaningful relief when traditional therapies no longer do.

When is it time to get concerned about knee pain?

Knee pain is easy to overlook in the beginning. Many people manage it with rest, ice packs, or an occasional painkiller. But when discomfort starts to interfere with everyday movement, it deserves closer attention. Persistent knee pain, even while resting or performing simple activities, often signals that the joint is under chronic stress. If the pain becomes sharper at night or after standing for long periods, it may indicate inflammation that is no longer temporary.

When pain no longer responds to medication or physiotherapy, it can suggest that the underlying problem has progressed. In osteoarthritis, ongoing inflammation leads to new, abnormal blood vessel formation around the knee, a process called angiogenesis. This can increase sensitivity and pain in the surrounding tissues. Swelling and warmth around the joint are also warning signs that inflammation is active and continuous, not the result of short-term strain.

Morning stiffness that lasts longer than half an hour is another key symptom. Healthy joints usually loosen up within minutes of movement, so prolonged stiffness means the joint lining is inflamed. Many people also notice a gradual loss of flexibility — difficulty bending or straightening the knee fully — which can make once simple movements, like climbing stairs or getting out of a chair, unexpectedly difficult.

As knee pain becomes a daily presence, quality of life begins to decline. Walking short distances might require effort. Some people lose confidence in their stability, worrying about slipping or falling. Over time, chronic pain can cause emotional exhaustion, frustration, or even avoidance of social and physical activity. These changes are important to acknowledge, as they reflect the broader impact of joint disease beyond the physical symptoms.

If these patterns sound familiar, it is time to seek a professional evaluation. Early medical attention can identify whether the pain stems from wear-and-tear arthritis, inflammation, or another underlying issue, and help determine when advanced, minimally invasive treatments such as Genicular Artery Embolization (GAE) may be appropriate.

Why do traditional treatments stop working?

Conservative care such as physiotherapy, anti-inflammatory medication, and corticosteroid injections often forms the first line of treatment for knee osteoarthritis. These methods can ease pain and improve function in the early stages, but their benefits tend to fade as the condition progresses. The reason is simple: while they manage symptoms, they do not address the ongoing inflammation and new blood vessel growth inside the joint. Over time, the cartilage continues to wear down, and pain returns despite consistent therapy. When movement remains limited and pain interferes with daily activity even after months of standard treatment, it may be time to consider newer, targeted options like Genicular Artery Embolization (GAE).

Who is an ideal candidate for Genicular Artery Embolization (GAE)?

GAE is intended for people who continue to experience pain despite physiotherapy, oral medication, or joint injections. It offers a solution for those who are not medically fit for knee replacement surgery or prefer to avoid it. Imaging studies, such as an MRI or X-ray, should show moderate to severe osteoarthritis but not complete cartilage loss or significant joint deformity. In those cases, surgery may still be more beneficial. For many, GAE provides meaningful pain relief and helps delay or reduce the need for a knee replacement in the future.

• Persistent pain: Ongoing discomfort even after trying conservative measures like physiotherapy and medications.
• Surgery not preferred: Individuals who are either not medically fit for knee replacement or want to avoid surgery.
• Moderate to severe osteoarthritis: Imaging (X-ray or MRI) confirms significant joint wear, but not complete cartilage loss.
• Functional limitation: Difficulty walking, climbing stairs, or performing daily activities due to pain and stiffness.
• Goal: Pain relief and improved mobility while delaying or reducing the need for knee replacement surgery.

What to keep in mind before choosing GAE

Many people hesitate to explore GAE because they believe it is still experimental. In reality, the procedure has gained wide clinical acceptance and is supported by growing research for safety and effectiveness. Another common concern is that the pain might return, but most patients experience long-lasting improvement. Some also worry about the idea of “cutting off blood flow.” GAE does not block circulation to healthy tissue. It precisely targets the small abnormal arteries that fuel inflammation, preserving normal joint function. Understanding these facts helps patients make confident, informed choices about their care.

• Imaging is essential: MRI or X-ray helps confirm osteoarthritis severity and guides treatment planning.
• Not a full replacement for surgery: GAE helps control pain and delay joint replacement, but it does not rebuild cartilage.
• Specialist evaluation: A consultation with an interventional radiologist ensures the procedure is appropriate and safe.
• Pre-procedure assessment: The doctor reviews vascular anatomy and checks for any coexisting medical conditions.
• Expected outcomes: Reduction in pain, swelling, and stiffness with gradual improvement in movement and quality of life.

Why choose RIVEA for Genicular Artery Embolization (GAE)?

At RIVEA Vascular Institute, Genicular Artery Embolization (GAE) is performed by Dr. Arjun Reddy, among the leading interventional radiologists in South India. His expertise ensures precise targeting of the knee’s blood vessels while safeguarding healthy tissue.

The institute features the Allia IGS 7 platform, a next-generation imaging system that enables highly accurate catheter navigation with optimized radiation control. This advanced technology enhances both safety and precision, which are crucial in minimally invasive procedures like embolization.

Each patient at RIVEA receives a personalized treatment plan based on arthritis severity, medical history, and recovery goals. Follow-up care includes pain monitoring, mobility assessments, and imaging when necessary. Treatment at RIVEA is focused on sustained pain relief, joint preservation, and maintaining independence without immediate surgery.