Is Cooled Radiofrequency Genicular Nerve Block and Ablation a Viable Option for the Treatment of Knee Osteoarthritis?

Abstract

Background The purpose of this study was to determine demographic and psychosocial factors that influence the effectiveness of cooled radiofrequency genicular nerve ablation (C-RFA) and block in patients with chronic knee pain secondary to osteoarthritis (OA). Methods A retrospective review was completed including patients with knee OA who underwent genicular nerve ablation or block or both. Patient information collected included opioid use, psychological comorbidities, smoking history, body mass index, and medical comorbidities. Success was defined using the Osteoarthritis Research Society International criterion of greater than or equal to 50% reported pain relief from the procedure. Patients without a diagnosis of knee OA and patients with ipsilateral total knee arthroplasty were excluded. Patient factors were compared between (1) those that did or did not respond to the initial block and (2) those that did or did not respond to C-RFA. Results Of the 176 subjects that underwent genicular nerve block, 31.8% failed to respond to the procedure. Subjects that failed the initial block were significantly more likely to have psychological comorbidities, smoking history, and diabetes. Of the subjects that proceeded to genicular nerve ablation, 53.7% reported less than 50% pain relief, and 46.3% reported pain relief greater than or equal to 50% at the first follow-up visit. While the presence of psychological comorbidities, smoking, and diabetes were associated with first-stage block failures, these patient factors were not associated with second-stage ablation failures. Conclusions C-RFA may be an effective adjunct therapy as part of a multimodal pain regimen; however, individual patient characteristics must be considered.

Cooled radiofrequency ablation versus cryoneurolysis of the genicular nerves for the symptomatic pain management in knee osteoarthritis: a study protocol of a prospective, randomized, single-blinded clinical trial

“…This has prompted the need for effective non–pharmacological therapies to control chronic arthritic pain [ 40 – 43 ]. In this setting, new techniques such as CRFA and CRYO have been developed, aiming at nerve blockage to improve pain and disability caused by KOA [ 13 , 16 – 18 , 24 , 44 – 46 ].…”

“…Participants in the CRFA cohort also showed a 46.2% improvement in the total WOMAC score at the 12-month time point. Carlone et al [ 46 ], in a recent retrospective review of 176 patients who underwent genicular nerve ablation, block, or both, found that 31.8% of the participants failed to respond to the block procedure, mainly due to the associated psychological comorbidities, smoking history, and diabetes. They also demonstrated that of the participants who underwent genicular nerve ablation, 53.7% reported less than 50% pain relief and 46.3% reported pain relief greater than or equal to 50% at the first follow-up visit.…”

Comparison of Genicular Nerve Block in Combination With Adductor Canal Block in Both Primary and Revision Total Knee Arthroplasty: A Retrospective Case Series

“…Chronic knee osteoarthritis (OA), an epidemic among aging populations, is a leading source of chronic pain in the United States and other developed countries [ 1 ]. The rise in prevalence of knee OA is a direct result of factors including longer life expectancy and increased body mass index (BMI), and it has been reported that at least 19% of American adults aged 45 years and older are affected [ 1 , 2 ]. Total knee arthroplasty (TKA) is a surgical procedure that provides relief for these patients suffering from severe pain and joint immobility related to knee OA when traditional conservative management has failed [ 3 ].…”