This case describes a 51-year-old woman with severe obesity (BMI 49.9 kg/m²) and end-stage bilateral knee osteoarthritis, whose extreme pain prevented physical activity and blocked weight-loss attempts. She was not eligible for total knee arthroplasty until losing ~25 kg, creating a therapeutic dead end.

Imaging confirmed advanced joint degeneration and high total fat mass. After multidisciplinary evaluation, a combined strategy was proposed: genicular artery transarterial embolization (TAE) to rapidly decrease pain and semaglutide to support long-term weight loss, alongside tailored nutrition.

MRI before treatment showed severe bone marrow edema. TAE was performed successfully, targeting hypervascular painful areas. One month later, pain dropped from NRS 9 to 4, bone marrow edema almost resolved, and the patient could begin low-impact exercise. Semaglutide titration and diet resulted in early weight loss and renewed motivation.

This case highlights TAE as a bridging option for patients with refractory OA and obesity who must lose weight before surgery. It also underscores the growing role of GLP-1 receptor agonists—not only for weight reduction but also for potential anti-inflammatory benefits. Early pain relief was likely driven by TAE, while semaglutide supports longer-term improvement and surgical readiness.

Combined TAE + GLP-1 RA therapy may offer a patient-centered pathway for individuals otherwise excluded from knee replacement, though larger studies are required to confirm safety, efficacy, and synergy.