EXCLUSIVE: The minimally invasive alternative to total knee replacement you need to know.
Genicular Artery Embolization is a new alternative you need to know about for chronic knee pain.
Internationally Renowned Interventional Radiologist Dr. George Foulard Explains New Treatment Option for Knee Osteoarthritis
Total knee replacement should be the last resort, not the first option.
Knee replacement surgery before 50 is rising. Board Certified Interventional Radiologist Dr. George Foulard MD, Founder of Liberty Medical, says you should exhaust minimally invasive options first.
Internationally renowned and board-certified vascular and interventional radiologist trained at Mount Sinai School of Medicine has performed GAE on over 300 patients in the New York region.
Dr. George Foulard, MD is a board-certified interventional radiologist who is a regional leader in performing Genicular Artery Embolization (GAE). He is the founder of Liberty Joint and Vascular and practices at Liberty Medical in New York, NY. As an internationally renowned pioneer in musculoskeletal embolization, he specializes in non-surgical, image-guided treatments and has performed one of the highest volumes of GAE procedures for chronic knee osteoarthritis pain in the New York metro region. He completed his residency in diagnostic radiology and a fellowship in vascular and interventional radiology at the Icahn School of Medicine at Mount Sinai.
Dr. George Foulard, an internationally renowned vascular interventional radiologist, says genicular artery embolization is a minimally invasive treatment for knee pain with promising results.
Over 800,000 knee replacements are performed in the United States every year and the number continues to grow. A large portion of the patients who undergo this invasive surgery have painful but otherwise mechanically sound knees.
Unfortunately, steroid injections, physical therapy, and NSAIDS are often not nearly enough to alleviate people’s symptoms to the point where they can continue to be active, independent, and pain-free.
Dr. George Foulard MD performs one of the highest volumes of genicular artery embolization procedures in New York.
What is Genicular Artery Embolization (GAE)?
GAE is an effective and safe minimally invasive treatment for knee pain. Genicular artery embolization decreases abnormal blood flow to the lining of the knee. Basically, when the knee, or just about any other part of the body, is inflamed for a long time, the body will grow new blood vessels to the area to help feed the inflammation. We target those blood vessels using an inert gelatin-like material delivered via a tiny catheter. The procedure is entirely outpatient and takes about 20 minutes. Patients walk out of the office and go home the same day and most patients notice a significant difference in their knee pain before they leave the building.
“GAE is becoming the gold standard for the millions of Americans suffering from knee pain and osteoarthritis.” – Dr. George Foulard MD, Founder of Liberty Medical
Why should patients get GAE done by you vs. another type of doctor?
GAE is my area of expertise. Adjacent specialties are not the same as direct specialization. Interventional radiologists train for years in this area. Today, some physicians offer GAE who are not trained in the specialty. You want to go to a provider who has specialty training. Interventional radiologists actually train in this for years. I studied this at Mount Sinai and am one of the few people in the New York region where this is my specialty. It is not a bolt on to a practice; it is the focus of my practice. I have taught cardiologists on how to do GAE procedures. Those with the best catheter skills are often interventional radiologists.
At Mount Sinai, I spent four years in radiology training at one of the top programs in the nation. I read over twenty thousand studies across residency. That is a lot of specialty training looking at images, not just reading reports.
“I read 20k studies across residency.” – Dr. George Foulard, Liberty Medical Founder.
Who should consider GAE?
GAE works best for patients with mild-to-moderate arthritis or patients with long-standing pain after knee replacement. Ultimately, who is and who isn’t a candidate is best determined by someone with specialized training. Even if you’ve been told you have severe bone-on-bone arthritis, it’s definitely still worth being evaluated to see what your options are.
What made you start Liberty Medical?
I had two major motivations to start this practice. The first is that both as a patient and a doctor, I’ve gotten to see so many different things that work and don’t work and I can’t help but imagine what the ideal practice would look like. Once I got that idea into my head, I couldn’t shake the desire to try to recreate it myself. Second, we are living during a very exciting time for interventional radiology. GAE represents a tremendous leap forward in terms of treating that pain effectively, safely, and without surgery.
When I look at the research coming out about GAE and all the other ways we are exploring to apply this technology, it’s obvious that we’re poised for a dramatic revolution in the treatment of joint pain and other diseases. I truly believe that interventional radiology is particularly well-equipped to lead this revolution. While other specialties like vascular surgery and interventional cardiology have complementary skills that allow them to be able to do these procedures, the unique skill set of interventional radiologist training prepares us particularly well to be able to effectively treat our patients with these exciting new techniques.
You come from a family of doctors. Are they entrepreneurs too?
My grandfather started his practice in the late 1940s when he got out of the army. He practiced well into his 80s and developed lifelong relationships with his patients. He was a classic community doctor in a way that is very much uncommon these days. My mother went on to practice with him and to develop much the same type of relationship with her patients.
When I think about the best way to expand access to the specialized techniques that interventional radiology has to offer, I think that’s the way to do it. We have to be accessible to patients in a way only possible in practices like this one. And while there are many Interventional Radiologists in large academic centers who have clinical practices, if you want to control and shape the patient experience for the better, being a practice owner instead of a large system employee is the way to do it.
What is the hardest part of entrepreneurship in the age of agentic AI?
This comes down to using the right tool for the job. It’s easy to fall victim to shiny-new-object syndrome and try to apply AI to all sorts of places it doesn’t belong, particularly areas where patients and doctors should be interacting on a personal level. The approach we’ve taken is to use AI to help build out our administrative processes to allow me and my staff maximum time and bandwidth to interact with and treat our patients in the personalized and caring way we’d all expect to be treated.
What are the top knee-replacement complications no one talks about?
The big one is persistent pain after/despite surgery. Fortunately, we’ve found GAE is actually fantastic for treating these patients. The other one is implant wear requiring additional surgery down the road. Knee replacement should definitely not be considered a one-and-done type of treatment, particularly for younger patients with knee pain.
Total knee replacement- first resort or last resort, and why?
Knee replacement really should be a last resort. I see so many patients who’ve been told they have bone-on-bone arthritis, and once we do X-rays we see that in fact their knees are still mechanically sound and have plenty of cartilage left. What they actually have is a very inflamed and painful joint. It makes much more sense to treat the inflammation and pain than to put the patient through a big open surgery with a prolonged recovery to treat an underlying mechanical problem that isn’t all that severe.
Do you treat shoulder pain too? My shoulder constantly hurts.
We’ve had remarkable success treating shoulder, hip, foot, and even hand pain with the same techniques. These parts of the body can be quite delicate, so you want to see someone with specific experience and expertise with these procedures.
Would weight loss help chronic knee pain? Injection recommendation?
Weight loss definitely helps reduce both knee pain and the rate of joint wear. Part of the reason is, of course, less weight equals less stress. However, carrying too much body weight can increase levels of systemic inflammation as well with all sorts of harmful effects.
For some patients, weight loss drugs can be enormously helpful. The decision about whether or not to use these drugs and which one to use should be made with your doctor. I will say that GLP-1 medications have a direct anti-inflammatory effect independent of weight loss, so using these drugs can improve joint pain sometimes even dramatically. There are also some very exciting new GLP-1 drugs in the pipeline being studied right now that hold a lot of promise for both weight loss and joint pain.
What are the top alternatives to GAE?
The typical progression of treatment for knee pain looks something like this. NSAIDS like ibuprofen, physical therapy, steroid and/or gel injections, then knee surgery. GAE seems to fit best in between injections and surgery. Injections either don’t work or stop working after some time often long before the knee is no longer mechanically sound. For those patients, doing nothing simply doesn’t cut it, but surgery is too dramatic of a next step. That’s exactly the kind of time when you should consider GAE.
Walk us through the GAE procedure from start to finish
The experience is nothing like surgery. Most patients are pleasantly surprised by how quick and easy the process is. We begin the appointment by going over the procedure including the risks, benefits, and post-procedure instructions. Most patients receive a mild sedative to ensure comfort throughout the procedure. The treatment itself takes about 20 minutes, after which they spend about an hour in our recovery center. Afterwards, everyone walks out on their own and spends the night in their own bed.
The procedure itself involves applying a small amount of local anesthetic at the ankle and using an X-ray machine to guide a tiny catheter into the arteries supplying the lining of the knee. After we map out the blood supply to the knee, that catheter is used to deliver a small volume of material to the areas of the knee where we see the results of chronic inflammation. The catheter is then removed and a small flexible band is applied around the ankle to hold gentle pressure on the catheter insertion site. The procedure itself is not painful. In fact, most patients don’t realize we’ve even started when I tell them we’re all done.
Complications are far less severe than those we see with knee replacement. Some patients experience a mild rash on the knee that goes away on its own or some temporary irritation from the material we use to treat the areas of inflammation. Of course, we discuss all of these questions in great detail when we meet in person.
After treating over 300+ patients with GAE, what have you learned? Why is everyone in so much pain? What do you think changed over the past decade?
I say this all the time: everyone is different. I see patients with terribly severe knee pain but not-so-severe X-rays and, on the other hand, unbelievably severe X-rays but moderate knee pain. We’re getting much better at tailoring treatment to each individual, but so much work remains until we truly understand this set of diseases.
We’ve seen a huge increase in the number of people living with obesity, and there’s no question this is contributing to how much knee pain we see. We’re seeing younger patients with more severe pain than in years prior. Fortunately, at the same time, the last ten years has also brought about huge shifts in how we understand and treat joint pain, and I expect that trend to continue.
Best shoes for chronic knee pain – heels or flats/sneakers?
The best advice I have is to find something that works for you. Everyone is different. I tend to favor sneakers with a good amount of shock absorption, arch support, and a stable, wide base, but you might have to try a few options to find one that works best for you. For example, some patients can develop foot pain if they wear shoes with too high and firm of an arch. Heels can cause problems due to the fact that they shift more load onto the front of the knee. That said, if your knee pain isn’t made worse by wearing heels from time to time, it’s fine to do so, but listen to your body.
Other product recommendations for StacyKnows readers?
I believe very strongly in the idea that every patient is different. Generally speaking, if something helps you with pain and isn’t making anything worse, it’s worth exploring. And if there’s any question, discuss it with your doctor.
One product I repeatedly recommend to patients is compression socks. So many of my patients have leg swelling and pain from causes both related to and unrelated to knee pain. These socks can be a huge help. You want to find a pair that goes up to just below the knee, fits correctly (tight but not uncomfortable), and that provides 20-30 mmHg of compression.
Top 5 things not to do with knee pain:
1. Don’t ignore or push through the pain.
2. Don’t jump straight to surgery.
3. Don’t assume your bone-on-bone just because someone told you that you are.
4. Don’t rely solely on pain medications.
5. Don’t discount the role of strength training and physical therapy.
AI IN HEALTHCARE / MED TECH
Patients using AI to prep for appointments without self-diagnosing
I think you hit the nail on the head. You want to use AI to help you through your care process without using it to self-diagnose.
Top 5 medical prompts for knee pain:
The important thing is to use AI to help organize and prepare for an appointment with your doctor not as a substitute for one:
1. “Help me describe my knee pain to my doctor.”
2. “What questions should I ask about GAE?”
3. “Help me prepare a list of treatments, medications, and supplements I’ve tried for my knee pain.”
4. “Help me gauge what activities or movements make my knee pain better or worse.”
5. “I’m nervous about my upcoming appointment or treatment. Help me list my concerns so I can discuss them with my doctor.”
Geoffrey Hinton’s claim that AI will replace radiologists — right or wrong?
Definitely wrong. He made that prediction in 2016, and since then we’ve only seen an expanding need for radiologists. In fact, the American College of Radiology anticipates a 26% increase in the supply of radiologists over the next thirty years.
Based on both the trends in the specialty and my own experience as well as Hinton’s more recent position, AI is a tool radiologists use to be more efficient and accurate. It does not replace the need for clinical judgment, technical skills, or the doctor patient relationship.
What is your take on robotic assisted knee replacement?
I’m not a surgeon, and I don’t perform knee replacements. That said, when I advise my patients who need to see surgeons, I emphasize the need to find someone who listens to their concerns and makes them feel at ease with their care over technical offerings. A lot of these technologies serve more as marketing differentiators than advantages in terms of patient experience or clinical outcomes.
Anything else our readers should know?
Radiologists, and particularly interventional radiologists, love solving problems. If you feel stuck and have not yet found a solution that works for you, go see one. You never know what kind of new and exciting therapies are out there.
Genicular Artery Embolization (GAE) holds tremendous promise for patients suffering from chronic knee pain. Expanded recognition of this effective treatment has the ability to change outcomes by empowering patients with access to information on new innovative treatment options.
How can people book an appointment with you for GAE?
You can book a consultation on our website at Liberty Medical.
