Genicular artery embolization as a minimally invasive treatment for knee osteoarthritis: systematic review and meta-analysis.

Abstract

Genicular artery embolization (GAE) has emerged as a novel intervention targeting the inflammatory cycle of knee osteoarthritis (KOA). While previous meta-analyses established efficacy, they were limited by small samples and embolic protocols. This systematic review incorporates recent trials and techniques, emphasizing on longitudinal improvement and durability of response. A systematic search of PubMed, EMBASE, and Cochrane Central was conducted from inception through October 2025. Studies reporting patient-reported outcomes (VAS, WOMAC, KOOS) were included. Data were pooled using random-effects models to quantify changes from baseline. Heterogeneity was assessed using I², τ², and 95% prediction intervals, and sensitivity analyses performed to evaluate robustness of estimates. A total of 18 studies comprising 534 patients demonstrated significant and sustained pain reduction, with mean VAS decreases of 3.96 (95% CI - 4.64 to - 3.27), 4.17 (95% CI - 4.81 to - 3.54), 4.36 (95% CI - 5.09 to - 3.63), and 4.53 (95% CI - 5.47 to - 3.60) points at 1, 3, 6, and 12 months, respectively. WOMAC and KOOS outcomes followed similar trajectories with improvements at 1 month and maintained through 12-month follow-up. Magnitude of VAS improvement exceeded commonly accepted clinically thresholds across all time points. Substantial heterogeneity (I² > 80%) was observed, reflecting differences in agents, selection criteria, and techniques. GAE provides meaningful and durable symptom relief for KOA refractory to conservative management. However, substantial heterogeneity and recent sham-controlled data indicate that the magnitude of treatment effect remains uncertain. These findings support standardization of protocols, selection criteria, and outcome reporting in future studies.