Radiofrequency ablation reduces pain for knee osteoarthritis: A meta-analysis of randomized controlled trials

Li, Guoqing; Zhang, Yongbin; Tian, Longlong; Pan, Junbo

doi:10.1016/j.ijsu.2021.105951

Cited by 17 publications

(9 citation statements)

References 20 publications

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“…The WOMAC score is widely applied in the evaluation of hip and knee OA for assessment of the activities of gait, daily living, general health, functional mobility, and quality of life, and has been identified as one of the highest performing outcome measures in terms of validity, reliability, interpretability, and responsiveness [ 41 – 43 ]. Furthermore, although the results for the effectiveness and safety of RF treatment were consistent between the current meta-analysis and previous meta-analyses by Zhang et al [ 40 ] and Li et al [ 44 ], the heterogeneity requires further analysis. In the present study, subgroup and sensitivity analyses were performed on RCTs to test the robustness of the pooled results and explore the potential sources of heterogeneity in our meta-analysis.…”

Section: Discussionsupporting

confidence: 85%

Efficacy and safety of radiofrequency treatment for improving knee pain and function in knee osteoarthritis: a meta-analysis of randomized controlled trials

2022

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Background The clinical utility of radiofrequency (RF) in patients with knee osteoarthritis (OA) remains unclear. We conducted a meta-analysis to systematically evaluate the efficacy and safety of RF treatment in patients with knee OA. Methods Searches of the PubMed, Web of Science, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Data databases were performed through August 30, 2021. The major outcomes from published randomized controlled trials (RCTs) involving patients with knee OA were compared between RF and control groups, including Visual Analogue Scale (VAS) or Numerical Rating Scale (NRS) scores, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Knee Score (OKS), Global Perceived Effect (GPE) scale, and adverse effects at available follow-up times. Results Fifteen RCTs involving 1009 patients were included in this meta-analysis, and the results demonstrated that RF treatment correlated with improvements in pain relief (VAS/NRS score, all P < 0.001) and knee function (WOMAC, all P < 0.001) at 1–2, 4, 12, and 24 weeks after treatment as well as patients’ degree of satisfaction with treatment effectiveness (GPE scale, 12 weeks, P < 0.001). OKSs did not differ significantly between the two groups. Moreover, treatment with RF did not significantly increase adverse effects. Subgroup analysis of knee pain indicated that the efficacy of RF treatment targeting the genicular nerve was significantly better than intra-articular RF at 12 weeks after treatment (P = 0.03). Conclusions This meta-analysis showed that RF is an efficacious and safe treatment for relieving knee pain and improving knee function in patients with knee OA.

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Section: Discussionsupporting

confidence: 85%

Efficacy and safety of radiofrequency treatment for improving knee pain and function in knee osteoarthritis: a meta-analysis of randomized controlled trials

2022

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“…In contrast to previous meta-analyses 28 , our study excluded controversial literature 29 and incorporated recently published papers. Our findings are more specific and have undergone thorough subgroup analysis, which was lacking in previous studies.…”

Section: Discussionmentioning

confidence: 99%

Is radiofrequency ablation effective in treating patients with chronic knee osteoarthritis? A meta-analysis of randomized controlled trials

Chen,

Yang,

Wang

et al. 2023

Annals of Medicine &Amp; Surgery

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Background and aims: This meta-analysis aimed to evaluate the short-term and long-term efficacy of radiofrequency ablation (RFA) and explore the role of diagnostic genicular nerve blocks in predicting treatment outcomes. Methods: A comprehensive literature search was conducted, and nine randomized controlled trials (RCTs) involving 714 participants were included in the analysis. Data extraction, risk of bias assessment, and subgroup analyses were performed. The primary outcome measures were pain scores at 6 and 12 months, assessed using visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Results: The meta-analysis revealed that RFA demonstrated a significant short-term efficacy in reducing pain compared to the control group at 6 months, as indicated by the pain scores (weighted mean difference [WMD]: -2.69, 95% confidence interval [CI]: -3.99, -1.40). Similarly, WOMAC scores at 6 months favored the RFA group (WMD: -4.40, 95% CI: -7.12, -1.68). However, the long-term efficacy of RFA at 12 months remained uncertain for both pain scores (WMD: -0.88, 95% CI: -2.36, 0.61) and WOMAC (WMD: 0.03, 95% CI: -0.25, 0.32). Subgroup analysis suggested that a positive result from the diagnostic genicular nerve blocks test was associated with a more favorable short-term outcome. Conclusion: This meta-analysis provides moderate-quality evidence supporting the short-term efficacy of RFA in reducing pain in patients with knee osteoarthritis. The inclusion of a diagnostic genicular nerve blocks test prior to RFA may help identify patients likely to benefit from the procedure. But it still needs more large sample studies to verify the results. However, further research is needed to determine the long-term efficacy of RFA in managing knee osteoarthritis pain.

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“…2 Surgical options such as total knee arthroplasty (TKA) can be effective in severe cases, but up to 40% may experience persistent pain, with 15% reporting severe, debilitating pain following joint replacement. [3][4][5] Genicular nerve radiofrequency ablation (RFA) has been touted as a safe and effective minimally invasive surgical alternative in patients with refractory knee OA (KOA), 6 though several well-designed sham-controlled trials failed to demonstrate benefit post-TKA using conventional RFA 7 8 and a recent large, multicenter database review reported only modest benefit in non-operated knees. 9 In this latter study, the use of cooled RFA and performing multiple lesions per targeted nerve were associated…”

Section: Introductionmentioning

confidence: 99%

“…Genicular nerve radiofrequency ablation (RFA) has been touted as a safe and effective minimally invasive surgical alternative in patients with refractory knee OA (KOA),6 though several well-designed sham-controlled trials failed to demonstrate benefit post-TKA using conventional RFA7 8 and a recent large, multicenter database review reported only modest benefit in non-operated knees 9. In this latter study, the use of cooled RFA and performing multiple lesions per targeted nerve were associated with improved outcomes, suggesting more aggressive lesioning strategies may be necessary to optimize treatment outcomes.…”

Section: Introductionmentioning

confidence: 99%

Bipolar radiofrequency ablation of the superomedial (SM), superolateral (SL) and inferomedial (IM) genicular nerves for chronic osteoarthritis knee pain: a randomized double-blind placebo-controlled trial with 12-month follow-up

Malaithong

Tontisirin

Seangrung

et al. 2022

Reg Anesth Pain Med

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BackgroundVariability in anatomy in the knees supports the use of aggressive lesioning techniques such as bipolar-radiofrequency ablation (RFA) to treat knee osteoarthritis (KOA). There are no randomized controlled trials evaluating the efficacy of bipolar-RFA.MethodsSixty-four patients with KOA who experienced >50% pain relief from prognostic superomedial, superolateral and inferomedial genicular nerve blocks were randomly assigned to receive either genicular nerve local anesthetic and steroid injections with sham-RFA or local anesthetic and steroid plus bipolar-RFA. Participants and outcome adjudicators were blinded to allocation. The primary outcome was Visual Analog Scale pain score 12 months postprocedure. Secondary outcome measures included Western Ontario and McMaster Universities Arthritis (WOMAC) and Patient Global Improvement-Indexes (PGI-I).ResultsBoth groups experienced significant reductions in pain, with no significant differences observed at 12 months (reduction from 5.7±1.9 to 3.2±2.6 in the RFA-group vs from 5.0±1.4 to 2.6±2.4 in the control-group (p=0.40)) or any other time point. No significant changes were observed between groups for WOMAC and PGI-I at the primary endpoint, with only the control group experiencing a significant improvement in function at 12-month follow-up (mean reduction from 91.2±38.2 to 67.1±51.9 in the RFA-group (p=0.06) vs from 95.8±41.1 to 60.6±42.8 in the control group (p=0.001); p=0.85 between groups).ConclusionOur failure to find efficacy for genicular nerve RFA, coupled with evidence showing that a plenitude of nerves supply the knee joint and preliminary studies indicating superiority of lesioning strategies targeting more than three nerves, suggest controlled trials using more aggressive lesioning strategies are warranted.Trial registration numberTCTR20170130003.

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Radiofrequency ablation reduces pain for knee osteoarthritis: A meta-analysis of randomized controlled trials

Cited by 17 publications

References 20 publications

Efficacy and safety of radiofrequency treatment for improving knee pain and function in knee osteoarthritis: a meta-analysis of randomized controlled trials

Efficacy and safety of radiofrequency treatment for improving knee pain and function in knee osteoarthritis: a meta-analysis of randomized controlled trials

Is radiofrequency ablation effective in treating patients with chronic knee osteoarthritis? A meta-analysis of randomized controlled trials

Bipolar radiofrequency ablation of the superomedial (SM), superolateral (SL) and inferomedial (IM) genicular nerves for chronic osteoarthritis knee pain: a randomized double-blind placebo-controlled trial with 12-month follow-up

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