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A secondary aim was to investigate changes in synovitis observed at 4 months and the correlation with other clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifty-eight patients were included (GAE group: 29, sham group: 29). Pain scores improved from 44.44 (95% CI: 38.87\u201350.02) at baseline to 65.61 (95% CI: 57.16\u201374.06) after 12 months in the GAE group and from 42.34 (95% CI: 36.45\u201348.22) to 58.15 (95% CI: 48.7\u201367.6) in the sham group. The between-group difference after 12 months was not significant (7.46; 95% CI: \u221213.63 to \u221228.56;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.25). There were no significant within-group or between-group changes for synovitis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Is GAE more effective than a sham procedure for mild-to-moderate knee osteoarthritis in the long term, and how does it affect synovitis?<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>There was no significant difference in pain reduction or synovitis between the two groups<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>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<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-026-12505-8","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T17:15:29Z","timestamp":1776705329000},"page":"6624-6633","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Long-term outcomes of genicular artery embolization for knee osteoarthritis: 12-month efficacy and secondary outcomes from a randomized sham-controlled clinical trial"],"prefix":"10.1007","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0243-6532","authenticated-orcid":false,"given":"Tijmen A.","family":"van Zadelhoff","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rianne A.","family":"van der Heijden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sita M. 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