Efficacy and safety of magnetic resonance-guided focused ultrasound treatment for refractory chronic pain of medial knee osteoarthritis

Abstract

Objective: To elucidate the efficacy and safety of MRgFUS in the treatment for refractory pain derived from medial knee OA. Methods: Twenty patients with medial knee OA eligible for total knee arthroplasty were included in this prospective, non-controlled study (UMIN000010193). MRgFUS treatment was provided at the site of most severe tenderness around the medial femorotibial joint of each patient under real-time monitoring of temperature. The goal temperature of the targeted bone surface was 55 C. Numerical rating scale (NRS) worst pain scores, Western Ontario and McMaster Universities osteoarthritis index (WOMAC) scores, EuroQol 5 dimensions index (EQ-5D) scores and pressure pain threshold (PPT) were evaluated before treatment (baseline) and at 1 week and 1, 3, 6, and 12 months post-treatment, respectively. Complications and adverse events were also assessed clinically and radiographically. Results: Treatment response (a 50% or greater decrease in NRS score) was seen in 14 patients (14/19, 73.7%) at 12 months post-treatment. Mean NRS score rapidly decreased at 1 month after treatment and continued to decline through the following 12 months. At final follow-up, mean NRS score was 3.2 ± 1.9, significantly lower than at baseline (p ¼ 0.0013). Mean WOMAC and EQ-5D scores also improved significantly from 1 month after treatment. Fifteen patients showed significant sustained increases in PPTs at the sites of most severe tenderness. No serious adverse events were observed during and after treatment. Conclusions: MRgFUS treatments were effective not only for managing refractory pain, but also for improving physical functions without adverse events in elderly patients with medial knee OA.

Effects of high tibial osteotomy combined with arthroscopy on local inflammation degree and gait activity index in patients with medial knee osteoarthritis

“…The surgical treatments for medial knee osteoarthritis include unicompartmental knee joint replacement, HTO and arthroscopic surgery. 12 Among the surgical options, HTO is a knee preserving approach, which has a high knee joint survival rate and is a relatively simple operation. By correcting the lower limb force line, the patient’s knee joint function can be effectively preserved.…”

Osteoarthritis-related knee pain: MRI-guided focused ultrasound ablation treatment

“…Osteoarthritis (OA) of the knee is a common cause of pain, functional disability, and reduced quality of life in the elderly [1,2]. The global prevalence of knee OA is estimated to be 16%, with an agestandardized prevalence of 4307.4 cases per 100,000 in 2020 [2,3].…”

“…Total knee replacement is a well-established treatment option for end-stage osteoarthritis, however not all patients are willing or able to undergo the surgery [1]. While the rates of signi cant complications are low, they still exist, speci cally death (0.7%), pneumonia requiring hospitalization (1.4%), readmission for additional knee surgery (0.9%), pulmonary embolism (0.8%), acute myocardial infarction (0.8%), and wound infection (0.4%) [5].…”

“…MRgFUS has also been considered for the treatment of other painful conditions, such as osteoarthritis. Based on characteristic tenderness to palpation of the joint, it has been hypothesized that destruction of nociceptors and primary afferent sensory nerves about the joint may provide relief [1]. Speci cally, two small studies from Japan evaluate the role of MRgFUS in knee OA [1,10].…”

“…Based on characteristic tenderness to palpation of the joint, it has been hypothesized that destruction of nociceptors and primary afferent sensory nerves about the joint may provide relief [1]. Speci cally, two small studies from Japan evaluate the role of MRgFUS in knee OA [1,10]. MRgFUS has also been described for the treatment of painful lumbar facet joints [11,12].…”