Little update, I forgot about this and the 10-day window to rollback to 23H2 expired so I had to deal with it
My best guess is that the problem may have been caused by Windows automatically installing the default AMD driver for my r5 430, in spite of Emudriver being installed previously. So it turns out I was was using ArcadeOSD with official drivers, instead of Emudriver.
So I DDU'd everything, reinstalled Emudriver, blocked official driver with "wushowhide" (not sure if that's going to work long term), and now Arcade OSD seems to be working.
Though it might be a bit slower was than before? There's an approximately half-second freeze when switching resolutions or doing timing adjustments. This seemed to be snappier in the past before 24H2
But it does work now so all is good.
I also installed a preview Windows update in this time, so perhaps it's possible that was what actually fixed it so I guess I don't know for sure.