Abstract 4349153: Genicular Artery Embolization for Knee Osteoarthritis: A Systematic Review of Sham-Controlled Randomized Trials

Background: Knee osteoarthritis (KOA) is associated with significant chronic pain and functional impairment. Genicular artery embolization (GAE), a minimally invasive procedure, targets abnormal synovial neovascularization linked to pain and inflammation in KOA. This systematic review evaluates the efficacy and safety of GAE versus sham procedures in adults with symptomatic KOA. Methods: A systematic literature search (PubMed, EMBASE, Scopus, Web of Science) up to March 2025 identified sham-controlled randomized controlled trials (RCTs) assessing GAE in symptomatic KOA. Data extracted included study design, patient demographics, interventions, pain outcomes (KOOS, VAS), functional outcomes (WOMAC, KOOS subscales), and adverse events. Study quality was assessed using the Cochrane Risk of Bias 2.0 tool. Results: Three RCTs (total n=138) were included. One trial (Bagla et al.) showed significant short-term pain relief at 1-month post-GAE (VAS: −50.8 vs −0.5, p<0.01), though the clinical meaningfulness of this statistically significant improvement remains uncertain. Other studies (Van Zadelhoff et al., Landers et al.) demonstrated modest pain improvements (KOOS) at 4 and 12 months without statistical significance. Functional outcomes varied: WOMAC scores significantly improved post-GAE in one trial, while another reported significant improvements in quality of life only with complete embolization. Notably, the included trials employed different embolization agents, introducing heterogeneity that may limit the generalizability of these findings. No serious adverse events were reported; minor adverse events, primarily catheter-site bruising, occurred infrequently and resolved spontaneously. Conclusions: GAE appears safe and may offer short-term symptomatic pain relief for select KOA patients. However, inconsistent findings, small sample sizes, methodological heterogeneity, and short follow-ups limit conclusive efficacy assessments. Larger, standardized RCTs with extended follow-up are essential to better define GAE's clinical role in managing knee osteoarthritis.