Perspective: Genicular artery embolization for knee osteoarthritis - When the hype doesn’t match the evidence

This paper summarizes the current evidence on genicular artery embolization (GAE) for the treatment of knee osteoarthritis (OA). The goal of this minimally invasive treatment is to reduce synovitis by embolizing peri-genicular neovascularization and subsequently alleviate pain. Multiple uncontrolled case series have generally demonstrated a promising efficacy of GAE with substantial, lasting pain reduction and improved function. However, these studies lack control groups, making it difficult to distinguish between treatment effect and placebo effect. Three sham-controlled randomized clinical trials (RCTs) have been published to date, with varying methodologies. While the first reported positive results, the most recent two RCTs reported no significant effect of GAE compared to a sham treatment. Moreover, systematic reviews have generally supported the efficacy of GAE but did not include the two most recent RCTs. Given the lack of robust evidence from updated systematic reviews including the most recent published studies, the growing clinical adoption of GAE is not justified and, in our opinion, premature.