Patient selection & referral workflow

Inclusion criteria

• Knee pain attributable to osteoarthritis, localized to the knee
• Symptom duration ≥ 3 months
• Moderate-to-severe pain despite conservative management
• Radiographic OA, Kellgren-Lawrence grade 1–3 (grade 4 considered case by case)
• Not a candidate for, or declining, total knee arthroplasty

Contraindications / exclusions

• Active local or systemic infection
• Prior arthroplasty of the index knee
• Inflammatory arthritis (e.g., rheumatoid) as the primary pain source — evaluate separately
• Pain referred from hip or spine; meniscal or ligamentous injury requiring surgery
• Severe renal insufficiency, uncorrectable coagulopathy, or significant peripheral arterial disease
• Pregnancy; severe contrast allergy not amenable to premedication

Recommended workup

• Weight-bearing AP, lateral, and sunrise knee radiographs
• Documentation of prior therapies and response
• Baseline pain score (VAS/NRS) and WOMAC or KOOS if available
• MRI optional but helpful to characterize synovitis and exclude alternative pathology
• Basic labs: creatinine/eGFR, CBC, coagulation studies as indicated

Referral workflow

1. 1Identify. Patient with symptomatic knee OA ≥ 3 months refractory to conservative therapy.
2. 2Send referral. Include clinic notes, treatment history, and recent weight-bearing knee X-rays (MRI if available).
3. 3IR consultation. History, exam, WOMAC/VAS baseline, imaging review; MRI ordered if needed to confirm synovitis and exclude other pathology.
4. 4Procedure. Outpatient GAE under moderate sedation; same-day discharge.
5. 5Shared follow-up. Outcome reports sent to referring provider at follow-up visits; patient returns to PT/exercise.