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

OBJECTIVES: 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. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.