Permanent vs. Temporary embolic agents in genicular artery embolization for knee Osteoarthritis: A systematic review and Meta-Analysis
Abstract
Purpose: To systematically describe the observed safety and pain outcomes of genicular artery embolization (GAE) for symptomatic knee osteoarthritis (KOA), compare embolic agent classes, and critically appraise the methodological quality of available evidence, including sham-controlled randomized controlled trial (RCT) design.
Methods: Adults with radiographic KOA who underwent transcatheter GAE and reported ≥ 1 patient-reported outcome measure were eligible. The primary outcome was VAS pain reduction at 12 months. Secondary outcomes included WOMAC and KOOS scores, technical success, and adverse events. Random-effects meta-analysis with REML estimation was used; prediction intervals were computed. Pre-specified subgroup analysis compared imipenem/cilastatin versus permanent microspheres.
Results: 22 studies (3 RCTs, 19 single-arm or comparative cohorts) comprising 633 patients and 719 knees were included. Pooled within-group VAS WMD at 12 months: -39.6 mm (95% CI, -47.1 to - 32.1; 95% prediction interval [PI], -58.4 to - 20.8; I2 = 76%; p 2 = 38%).
Conclusions: GAE is consistently associated with large within-group pain reductions; however, these pre-post estimates are descriptive and do not establish procedure-specific causal efficacy. Three sham-controlled RCTs did not demonstrate significant between-group benefit, representing the highest-quality evidence currently available. Embolic agent class does not significantly influence pain-reduction outcomes; however, safety…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 633 participants or records.
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