Preoperative use of the modified radiofrequency neuroablation of the genicular and cutaneous nerves of the knee joint for alleviating postoperative pain after arthroplasty

Abstract

The aim of the study. To improve the effectiveness of pain syndrome management in the postoperative period in patients after knee arthroplasty with radiofrequency neuroablation (RFNA). Materials and methods. A prospective, open, randomized study on the treatment result analysis of 93 patients with knee joint osteoarthritis of the III–IV stage was conducted. Patients were divided into two groups: the study group (n = 44) and the comparison group (n = 49). The study group patients underwent arthroplasty of one knee and RFNA of the genicular and cutaneous nerves in the preoperative period. The comparison group patients underwent only knee arthroplasty. Assessment of pain intensity, functional status and quality of life of patients was performed using the VAS, WOMAC, KOOS questionnaires before treatment, 1.5, 3 and 6 months after surgery, taking into account the overall quality of life according to the SF-36 questionnaire and the possibility of developing neuropathic pain component according to the PainDetect questionnaire. Results. The result analysis obtained with the VAS showed pain reduction in both groups in 6 months after total knee arthroplasty (TKA), in the study group – 2 (2; 2) points, in the comparison group – 3 (2; 3) points. The results assessed with the WOMAC questionnaire showed greater improvement in treatment outcomes among patients who underwent knee arthroplasty in combination with RFNA – 32 (28; 34) points after 6 months. In the comparison group, there was also an improvement in functional status on examination in 1.5 months after surgery, but with less effective reduction of pain and physical recovery, which was seen on the examination in 6 months – 33.0 (28.5; 37.0) points. The analysis using the KOOS questionnaire showed a positive increase in postoperative indicators in both groups of patients, and it was 41.88 (37.20; 44.79) points in the comparison group and 47.67 (40.63; 50.51) points in the study group during a 6-month follow-up after arthroplasty. The SF-36 result analysis in 6 months after surgical treatment showed nearly identical restore of the psychological component of health in both patient groups – 56.63 (55.83; 59.03) points in the comparison group and 58.96 (54.24, 60.35) points – in the study group. The study group demonstrated better restoration of the physical component of health. The neuropathic component of pain was not detected among the examined groups of patients using the PainDetect questionnaire. Conclusions. RFNA of the genicular nerves and additional ablation of cutaneous nerves reduces the intensity of pain in the postoperative period after knee replacement and allows patients more quickly and easier restore functional activity and improve quality of life.