What question did this study set out to answer?

The aim was to evaluate the efficacy of genicular artery embolization for pain relief and changes in synovitis in knee osteoarthritis over 12 months.

April 22, 2026European Radiology0 citationsOpen Access

Long-term outcomes of genicular artery embolization for knee osteoarthritis: 12-month efficacy and secondary outcomes from a randomized sham-controlled clinical trial

TZTijmen A. van ZadelhoffErasmus MC RHRianne A. van der HeijdenUniversity of Wisconsin–Madison SBSita M. A. Bierma-ZeinstraErasmus MC

Key Points

The aim was to evaluate the efficacy of genicular artery embolization for pain relief and changes in synovitis in knee osteoarthritis over 12 months.
Randomized controlled trial with patients having mild to moderate knee osteoarthritis.
Participants were assigned to receive either genicular artery embolization or sham treatment with follow-ups at 1, 4, 8, and 12 months.
Pain and synovitis were assessed using scoring and MRI.
Pain scores improved significantly in both groups, but the between-group difference was not significant at 12 months.
No significant changes in synovitis were observed in either group.
The findings suggest sustained placebo effects rather than true treatment efficacy for GAE.

Abstract

Abstract Objectives To determine if genicular artery embolization (GAE) is more effective in relieving pain symptoms after 12 months compared to a sham procedure in patients with mild to moderate knee osteoarthritis. A secondary aim was to investigate changes in synovitis observed at 4 months and the correlation with other clinical outcomes. Materials and methods A randomized controlled trial included patients with mild to moderate knee osteoarthritis unresponsive to conservative treatment, who were randomly assigned to receive either GAE or sham treatment. Follow-up was at 1, 4, 8, and 12 months. Pain was assessed using the Knee Injury and Osteoarthritis Outcome Score, and synovitis was imaged with contrast-enhanced MRI at baseline, 1, and 4 months. Outcomes were compared using generalized estimating equations. Results Fifty-eight patients were included (GAE group: 29, sham group: 29). Pain scores improved from 44.44 (95% CI: 38.87–50.02) at baseline to 65.61 (95% CI: 57.16–74.06) after 12 months in the GAE group and from 42.34 (95% CI: 36.45–48.22) to 58.15 (95% CI: 48.7–67.6) in the sham group. The between-group difference after 12 months was not significant (7.46; 95% CI: −13.63 to −28.56; p = 0.25). There were no significant within-group or between-group changes for synovitis. Conclusion Patients undergoing GAE and sham GAE both demonstrate an equal sustained pain reduction at 12 months follow-up, with no differences in synovitis reduction or other clinical outcomes. These results suggest a sustained placebo effect in the long term and do not support the clinical implementation of GAE as a treatment for KOA patients. Key Points Question Is GAE more effective than a sham procedure for mild-to-moderate knee osteoarthritis in the long term, and how does it affect synovitis? Findings There was no significant difference in pain reduction or synovitis between the two groups . Clinical relevance Pain reduction after GAE appears mainly placebo-driven. The placebo effect is sustained up to 12 months. Furthermore, synovitis was unaffected by the procedure. Therefore, our findings do not support clinical implementation . Graphical Abstract

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