Clinical and technical factors associated with knee radiofrequency ablation outcomes: a multicenter analysis

Chen, Yi‐An; Vu, To Nhu; Chinchilli, Vernon M.; Farrag, Mohamed; Roybal, Alexandra R.; Huh, Albert; Cohen, Z.; Becker, Adam B.; Arvanaghi, Babak; Agrawal, Mrinal; Ogden, Jacob; Cohen, Steven P.

doi:10.1136/rapm-2020-102017

Cited by 38 publications

(38 citation statements)

References 35 publications

(27 reference statements)

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“…It is important to note that more than half of the patients in their study underwent bilateral GNRFA, suggestive of higher baseline disease burden and lower potential for symptom improvement in their sample. Our results on comparative probability of pain relief were consistent with a previous retrospective study which reported that the use of c-RFA, when compared with t-RFA, was associated with a 16% decrease in percentage pain reduction (p=0.03), even though another study showed the opposite association 27 28…”

Section: Discussionsupporting

confidence: 91%

Cooled and traditional thermal radiofrequency ablation of genicular nerves in patients with chronic knee pain: a comparative outcomes analysis

Grits

Foorsov

et al. 2022

Reg Anesth Pain Med

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IntroductionGenicular nerve radiofrequency ablation (GNRFA) is a minimally invasive intervention for patients with chronic knee pain (CKP) not responding to conservative treatments. Few investigations have compared treatment outcomes of cooled-RFA (c-RFA) and thermal-RFA (t-RFA), two common approaches of GNRFA. This study aims to investigate and compare outcomes, including probability of treatment success, between c-RFA and t-RFA in patients with CKP.MethodsThis retrospective cohort study analyzed a total of 208 propensity score matched patients, including 104 patients who received c-RFA and 104 patients who received t-RFA. The primary outcome was probability of pain relief after the procedure, defined as reduction in Numeric Rating Scale (NRS) pain score of 2 or greater. The secondary outcomes were degree of NRS pain score reductions, duration of relief, and the probability of patients receiving TKA within 1 year of treatment.ResultsT-RFA was associated with a higher probability of pain relief within 1, 3, and 6 months after procedure when compared with c-RFA. Probabilities of pain relief from t-RFA and c-RFA were 62% (95% CI 51% to 71%) and 43% (95% CI 34% to 53%; p=0.01) within 1 month, 78% (95% CI 68% to 85%) and 55% (95% CI 45% to 64%; p<0.001) within 3 months, and 79% (95% CI 70% to 86%) and 59% (95% CI 49% to 68%; p<0.01) within 6 months, respectively. t-RFA was also associated with greater mean NRS pain score reduction at 1 month after procedure: −4.71 (95% CI −5.3 to −4.1) when compared with −3.59 (95% CI −4.3 to −2.9; p=0.02) from c-RFA. T-RFA and c-RFA were comparable in pain score reduction at 3, 6, 9 and 12 months after procedure. Both groups demonstrated comparable duration of relief and probability of patients receiving TKA within 1 year.DiscussionBoth t-RFA and c-RFA effectively reduced NRS pain scores in most patients with CKP within the 1 year follow-up period. Genicular nerve t-RFA was associated with a higher probability of treatment success and a greater degree of pain relief at 1 month after the procedure when compared with c-RFA in propensity score matched patients with CKP.

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Section: Discussionsupporting

confidence: 91%

Cooled and traditional thermal radiofrequency ablation of genicular nerves in patients with chronic knee pain: a comparative outcomes analysis

Grits

Foorsov

et al. 2022

Reg Anesth Pain Med

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“…As such, we assumed that only patients in the CRFA arm received GNB and accrued the costs. While discussions continue about the need for one or two GNBs, recent data reaffirm that favourable, consistent, and durable treatment outcomes can be achieved following a single GNB with ≥50% relief [ 22 , 27 , 36 ]. Modification of the cost assumptions to reflect real-world clinical practice, including in-office HA administration without ultrasound guidance (versus an outpatient facility using ultrasound) and in-office GNB for CRFA patients (versus outpatient consultation), did not change the overall conclusion that CRFA is cost effective versus HA.…”

Section: Discussionmentioning

confidence: 99%

Cooled radiofrequency ablation of the genicular nerves for chronic pain due to osteoarthritis of the knee: a cost-effectiveness analysis compared with intra-articular hyaluronan injections based on trial data

Desai

Bentley

Keck

2022

BMC Musculoskelet Disord

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Background Effective symptom control in painful knee osteoarthritis (OA) may improve patient quality of life. In a randomised crossover trial (NCT03381248), COOLIEF* cooled radiofrequency ablation (CRFA) reduced pain and stiffness and improved physical function and quality of life compared with intra-articular hyaluronan (HA) injections. The present study aimed to establish the cost effectiveness of CRFA versus intra-articular HA injections for treating moderate-to-severe OA knee pain from a US Medicare perspective. Methods We conducted a cost-effectiveness analysis using utility data (EQ-5D) from the randomised crossover trial of CRFA versus intra-articular HA injections, which had follow-ups at 1, 3, 6, and 12 months. Patients in the HA group with unsatisfactory outcomes (e.g., continued pain) at 6 months could cross over to CRFA. Economic analysis outcomes included quality-adjusted life-years (QALYs), costs, and cost effectiveness (cost per QALY gained). Base-case analyses were modelled on a 6-month time horizon (to trial crossover). Due to limited trial data in the HA arm beyond 6 months, scenarios explored potential outcomes to 12 months if: 1) Utility with HA persisted for a further 6 months; 2) A second HA injection was received at 6 months and achieved the same utility change for the second 6 months. In both scenarios, the CRFA arm used trial data for patients who received CRFA from baseline to 12 months. Alternative costing scenarios were also explored. Results CRFA resulted in an incremental QALY gain of 0.020 at an incremental cost of US$1707, equating to an incremental cost-effectiveness ratio (ICER) of US$84,392 per QALY over 6 months, versus intra-articular HA injections. Extending the analysis to 12 months and assuming persistence in utility in the HA arm resulted in a larger utility gain for CRFA (0.056 QALYs) and a lower ICER of US$30,275 per QALY. If patients received a second HA injection, the incremental benefit of CRFA out to 12 months was reduced (QALY gain 0.043) but was offset by the costs of the second HA injection (incremental cost US$832). This resulted in an ICER of US$19,316 per QALY. Conclusions CRFA is a cost-effective treatment option for patients with OA-related knee pain considering the typical US threshold of US$100,000/QALY.

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“… 21 , 35 , 36 The cadaver study of Fonkoue et al 36 proposes revised anatomical landmarks for the original genicular nerves. Chen et al 37 and McCormick et al 35 advocate that ablation of up to ten genicular nerves could improve outcomes of this treatment. Future clinical trials incorporating this improved knowledge of the innervation of the knee are necessary for optimalization of the RF technique for chronic knee pain.…”

Section: Discussionmentioning

confidence: 99%

A retrospective study on patients with chronic knee pain treated with ultrasound‐guided radiofrequency of the genicular nerves (RECORGEN trial)

et al. 2021

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Introduction Radiofrequency (RF) treatment of the genicular nerves is a promising treatment for chronic osteoarthritic and persistent postsurgical knee pain (PPSP), refractory to conventional medical management. Methods The RECORGEN study is a retrospective single‐center cohort study of patients treated with ultrasound‐guided conventional RF of the genicular nerves for chronic knee pain in Hospital Oost‐Limburg, Genk from September 2017 to June 2020. Subgroup analysis based on etiology of pain (PPSP and degenerative knee pain) was performed in addition to the total study population analysis. Outcome parameters were global perceived effect (GPE), Numeric Rating Scale for pain, consumption of strong opioids, and safety of the treatment at 6 weeks and cross‐sectionally at a variable time point. Treatment success was defined as GPE≥50%. Results Sixty‐eight cases were screened of which 59 (46 diagnosed with PPSP and 13 with degenerative knee pain) were included in the study. Treatment success at 6 weeks was achieved in 19 of 59 interventions (32.2%) and was similar in both groups. Seventeen responders were evaluated at follow‐up. 45.1% (8/17) continued to have a positive effect at the second time point. The mean duration of effect of the RF treatment was 8.3 months. Safety analysis at 6 weeks and at the second time point showed a good safety profile of the treatment. Conclusion Conventional RF of the genicular nerves was clinically successful in more than 30% of the study population refractory to conventional medical management. Overall, the treatment was well tolerated. The mean duration of effect was 8.3 months.

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Clinical and technical factors associated with knee radiofrequency ablation outcomes: a multicenter analysis

Cited by 38 publications

References 35 publications

Cooled and traditional thermal radiofrequency ablation of genicular nerves in patients with chronic knee pain: a comparative outcomes analysis

Cooled and traditional thermal radiofrequency ablation of genicular nerves in patients with chronic knee pain: a comparative outcomes analysis

Cooled radiofrequency ablation of the genicular nerves for chronic pain due to osteoarthritis of the knee: a cost-effectiveness analysis compared with intra-articular hyaluronan injections based on trial data

A retrospective study on patients with chronic knee pain treated with ultrasound‐guided radiofrequency of the genicular nerves (RECORGEN trial)

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