Geniculate Artery Embolization for Knee Osteoarthritis

Inclusion Criteria 1. Age ≥40 years with no upper age restriction, provided performance status permits procedural candidacy 2. Symptomatic mild-to-severe knee osteoarthritis (Kellgren-Lawrence grade 2-4) on radiographs within 6 months of enrollment 3. Chronic knee pain (NRS ≥4/10) for ≥3 months despite conservative treatment including steroid injections, physical therapy, and/or analgesic medications 4. Inadequate candidate for or refusal of surgical intervention (e.g., total knee arthroplasty) due to cancer-related comorbidities, ongoing treatment, or participants preference 5. Active cancer diagnosis (solid tumor or hematologic malignancy) confirmed at MD Anderson Cancer Center Exclusion Criteria * Active joint infection or suspected septic arthritis * Life expectancy \<6 months * Prior knee arthroplasty in the index knee * Coagulopathy or contraindications to angiography * GFR \<30 mL/min/1.73m² * Peripheral artery disease with stenosis or occlusion of lower extremity vasculature (relative contraindication per SIR standards, given geniculate artery collateral perfusion role) * Radiographically normal knee joint (KL grade 0-1) - alternative etiologies should be sought * Known active autoimmune/inflammatory arthropathy (e.g., rheumatoid arthritis, psoriatic arthritis) * Any medical condition or clinical abnormality that, per investigator judgment, precludes safe participation in and completion of the study