Cooled Radiofrequency Ablation for Chronic Joint Pain Secondary to                     Hip and Shoulder Osteoarthritis

Kallas, Omar; Chockalingam, Arun; Singer, Adam D.; Wong, Philip Kin-Wai; Kokabi, Nima; Bercu, Zachary L.; Umpierrez, Monica; Tran, Andrew; Reimer, Nickolas B.; Oskouei, Shervin V.; Gonzalez, Felix M.

doi:10.1148/rg.210074

Cited by 6 publications

(6 citation statements)

References 41 publications

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“…Ablation is typically done using high temperatures, cold temperatures, or chemicals. Initially one to two lidocaine nerve block injections to the problematic nerves is done and then the physician will go forward with RFA only if the injection showed evidence that the RFA target is the nerve that produces pain symptoms (Kallas et al, 2022). The benefit of the procedure is that it is precise and specifically targets the pain-producing nerve.…”

Section: Physical Medicine and Rehabilitation Modalitiesmentioning

confidence: 99%

Physiatry for Treating Hip, Knee, and Back Pain

Mohammadi,

Sedlak

2024

Orthopaedic Nursing

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Physical Medicine and Rehabilitation (PM&R) is a rapidly expanding field. Physicians who practice PM&R are known as physiatrists and provide care primarily for patients who have disabilities or physical impairments affecting the musculoskeletal system, brain, and spinal cord. Physiatrists may work in an inpatient or outpatient setting, with outpatient physiatrists being an invaluable resource in treating patients experiencing pain. It is worthwhile to refer patients experiencing hip, knee, or back pain to a PM&R specialist because of their skill in making specific and accurate diagnoses, as well as providing a wide range of modalities to treat pain and augment function such as management of pain medications, osteopathic manipulative therapy, trigger point injections, intra-articular steroid injections, orthobiologic therapy, and interventional spinal procedures. Emphasis is on the use of the least invasive modality before employing more invasive treatments. The need for physiatrists to help individuals maximize function and enhance quality of life is increasing with the aging population, expanding workforce of older adults, and a growing population of people with a disability, especially since the COVID-19 pandemic.

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Section: Physical Medicine and Rehabilitation Modalitiesmentioning

confidence: 99%

Physiatry for Treating Hip, Knee, and Back Pain

Mohammadi,

Sedlak

2024

Orthopaedic Nursing

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“…RF of the obturator and femoral nerve articular sensory branches has shown promising results in the management of hip OA-related pain, especially in individuals who cannot undergo, have long wait times until, or have persistent pain following total hip arthroplasty (THA) (50). In 2022, Tran et al established the effectiveness of cooled RF in managing hip pain from OA at 6 months after treatment in individuals whose conservative treatments failed and were not surgical candidates due to comorbidities or unwillingness to undergo THA through targeting of the obturator and femoral nerve branches.…”

Section: Rf In Hip Oamentioning

confidence: 99%

“…The targets of cooled RF are the suprascapular, axillary, and lateral pectoral nerve articular sensory branches of the glenohumeral joint. Cooled RF appears to be a promising tool for treating OA-related pain, especially in individuals who cannot undergo shoulder arthroplasty, have long wait times, or have persistent pain after shoulder arthroplasty ( 50 ). Figure 2 shows a case of shoulder pain due to OA treated with pulsed RF.…”

Section: Upper Limb Rf Treatmentsmentioning

confidence: 99%

Upper limb and lower limb radiofrequency treatments in orthopaedics

2023

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Radiofrequency (RF) is a minimally invasive technique for disrupting or altering nociceptive pathways to treat musculoskeletal neuropathic and nociplastic pain. RF has been employed to treat painful shoulder, lateral epicondylitis, knee and hip osteoarthritis, chronic knee pain, Perthes disease, greater trochanteric pain syndrome, plantar fasciitis, and painful stump neuromas; it has also been employed before and after painful total knee arthroplasty and after anterior cruciate ligament reconstruction. The benefits of RF include the following:it is safer than surgery; there is no need for general anaesthesia, thereby reducing adverse effects; it alleviates pain for a minimum of 3–4 months; it can be repeatable if necessary; and it improves joint function and minimizes the need for oral pain medication. RF is contraindicated for pregnant women; unstable joints (hip, knee, and shoulder); uncontrolled diabetes mellitus; presence of an implanted defibrillator; and chronic joint infection (hip, knee, and shoulder). Although adverse events from RF are unusual, potential complications can include infection, bleeding, numbness or dysesthesia, increased pain at the procedural site, deafferentation effect, and Charcot joint neuropathy. Although there is a risk of damaging non-targeted neural tissue and other structures, this can be mitigated by performing the technique under imaging guidance (fluoroscopy, ultrasonography, and computed tomography). RF appears to be a valuable technique for alleviating chronic pain syndromes; however, firm proof of the technique’s efficacy is still required. RF is a promising technique for managing chronic musculoskeletal of the limbs pain, particularly when other techniques are futile or not possible.

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“…Radiofrequency ablation (RFA) is an established treatment for back pain and peripheral joint pain. [1][2][3][4] RFA is a minimally invasive therapy that generates thermal damage, known as lesions, to impair pain signals in sensory nerves. 5 In previous research, several probe configurations and generator settings were compared with assess RFA lesion shape.…”

Section: Introductionmentioning

confidence: 99%

Water-circulating probes significantly modify lesion length and axon damage in cooled radiofrequency ablations when compared with similar-sized standard radiofrequency probes in rats

Cobbs,

Alas,

Yadav

et al. 2023

Reg Anesth Pain Med

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IntroductionPreclinical research demonstrated water-cooled radiofrequency (CRF) ablations have a significant impact on structural and functional changes compared to standard radiofrequency (SRF) ablations. Clinical procedures utilizing RF to treat chronic pain conditions also show sustained functional outcomes. We hypothesize that the design of the RF probes plays an important role in interventional procedure success, but it remains unclear which specific design features.MethodsRF ablations were performed in male Lewis rats (n=51) using multiple-sized probes for CRF (17 Ga/2 mm and 17Ga/4 mm) and SRF (22Ga/5 mm, 18Ga/10 mm and 16Ga/10 mm) to evaluate generator energy output, lesion length, axon damage by histology and nerve function analysis via electromyography. To exclude probe design variables beyond size and remain objective, we tested cooled probes with and without water circulation, which resulted in the CRF probe performing like an SRF probe.ResultsConsistent with our previous findings in smaller probes, CRF large probes delivered more energy (p<0.01) and generated multiple zones of thermal damage in sciatic nerves. When the water-circulating feature was turned off, however, energy output (p<0.001) and lesion length (p<0.05) was significantly reduced. CRF probes with the water circulation also featured significantly more axonal disruption, than larger sized SRF probes (p<0.0001).ConclusionsOverall, this data confirms that CRF’s water-circulating technology has a greater impact on energy deposition, lesion length and axon damage compared with SRF ablations. Moreover, results suggest that the structural differences between RF modalities cannot be solely attributed to probe size, and it may shed light on its differences in clinical outcomes.

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Cooled Radiofrequency Ablation for Chronic Joint Pain Secondary to Hip and Shoulder Osteoarthritis

Cited by 6 publications

References 41 publications

Physiatry for Treating Hip, Knee, and Back Pain

Physiatry for Treating Hip, Knee, and Back Pain

Upper limb and lower limb radiofrequency treatments in orthopaedics

Water-circulating probes significantly modify lesion length and axon damage in cooled radiofrequency ablations when compared with similar-sized standard radiofrequency probes in rats

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