Genicular artery embolization for knee osteoarthritis: A systematic review of sham-controlled randomized trials.

Background: Knee osteoarthritis (KOA) is a degenerative joint disease associated with chronic pain and functional decline. Genicular artery embolization (GAE) is a minimally invasive intervention that targets abnormal synovial neovascularization. This systematic review evaluates the efficacy and safety of GAE compared with sham procedures in patients with symptomatic KOA. Methods: A systematic search of PubMed, EMBASE, Scopus, and Web of Science was conducted through March 2025. Only sham-controlled randomized controlled trials (RCTs) enrolling adults with symptomatic KOA were included. Data were extracted on study design, patient characteristics, interventions, outcomes, and adverse events. Risk of bias was assessed using the Cochrane RoB 2.0 tool. Results: Three sham-controlled RCTs with a total of 138 patients were included. GAE demonstrated short-term pain reduction, particularly in VAS scores, with one trial showing a significant improvement at 1 month (-50.8 vs -0.5). KOOS pain scores improved modestly across studies but lacked statistical significance. Functional outcomes were mixed; one trial reported significant improvement in WOMAC function, and another found enhanced quality of life in patients undergoing complete embolization. No serious adverse events occurred; minor complications such as catheter-site bruising were infrequent and self-limited. Conclusions: GAE appears to be a safe and minimally invasive treatment that may provide short-term symptomatic relief in select KOA patients. However, limited sample sizes, methodological variability, and short follow-up periods constrain definitive conclusions. Larger, standardized trials with longer follow-up are necessary to confirm efficacy and optimize patient selection.