Closing the treatment gap in knee osteoarthritis — the GEKO trial begins

Knee osteoarthritis is one of the most common musculoskeletal conditions, affecting almost one in five people over the age of 45 in the UK — around 4 million people. For many, it means living with chronic pain, limited mobility, and a gradual decline in quality of life. At its most severe, the only effective option is knee replacement surgery.

But what about those who aren’t yet at that stage? Despite trying physiotherapy, anti-inflammatories, and combinations of painkillers, many patients remain stuck in a treatment gap. Their pain is poorly controlled, yet surgery is not an option.

A new approach — genicular artery embolisation (GAE) — might offer hope. The procedure blocks small blood vessels around the knee that are thought to drive inflammation and pain. Early studies have hinted at benefit, but the evidence so far is mixed: one small trial showed no improvement, while another found a modest reduction in pain. Despite this uncertainty, the technique is already being used internationally.

This is why the GEKO trial has opened in the UK. Funded by the NIHR, GEKO will be the largest and most rigorous study of GAE to date. The trial will randomise 216 participants across 12 UK hospitals to receive either embolisation or a high-fidelity placebo procedure. The primary aim is simple: does GAE actually reduce knee pain? Researchers will also examine whether it improves function, reduces the need for painkillers, and enhances overall quality of life. Medical imaging, such as MRI scans and angiograms, will help shed light on what changes are happening inside the knee.

The first patient has already been consented, marking the start of a two-year study led by Professor Andrew Price (University of Oxford) and Dr Raman Uberoi (Oxford University Hospitals NHS Foundation Trust), in collaboration with researchers from the University of Nottingham, the University of Warwick, and East Suffolk and North Essex NHS Foundation Trust. The work is managed by the Surgical Intervention Trials Unit (SITU) and the Oxford Clinical Trials Research Unit (OCTRU) within NDORMS, University of Oxford.

If successful, GAE could represent a major shift in the management of knee osteoarthritis — offering a minimally invasive procedure that helps patients manage pain and improve their quality of life. Results are eagerly awaited and will be presented at international meetings and in leading journals.

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