Radiofrequency Ablation in Cooled Monopolar or Conventional Bipolar Modality Yields More Beneficial Short-Term Clinical Outcomes Versus Other Treatments for Knee Osteoarthritis: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

Wu, Limin; Li, Yifan; Si, Haibo; Zeng, Yi; Li, Mingyang; Liu, Yuan; Shen, Bin

doi:10.1016/j.arthro.2022.01.048

Cited by 15 publications

(12 citation statements)

References 51 publications

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“…In a systematic review and meta-analysis of level I and II studies reported in 2022 (grade 2 of evidence), Wu et al assessed various RF treatments for knee OA. The authors' goal was to determine the best modality, target, number of electrodes, and image guidance for improving knee pain and function (47). Twenty-one suitable RCTs (from 2011 to 2021, involving 1818 individuals) with eight RF treatments, six intra-articular injections, NSAIDs, exercise, and placebo were evaluated.…”

Section: Rf In Knee Oamentioning

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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Section: Rf In Knee Oamentioning

confidence: 99%

Upper limb and lower limb radiofrequency treatments in orthopaedics

2023

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“…31 Wu et al stated that the three genicular nerves could be chosen as the targets in the three modalities, and the articular cavity can also be chosen as the target in the pulsed modality. 4 Conventional bipolar genicular nerve radiofrequency ablation had the greatest net benefit on the VAS at 6 months and cooled monopolar genicular nerve radiofrequency ablation had the greatest net benefit on the WOMAC at 6 months. They conclude that patients respond better to the cooled modality compared to the conventional and pulsed modalities.…”

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confidence: 92%

“…They also described the differences between the three different modalities (cooled, conventional, and pulsed) of radiofrequency in an understandable way in section 4.1 of the article. 4 The authors also sought to compare targets (genicular nerves vs articular cavity), number of electrodes (bipolar vs monopolar), and image guidance (ultrasound vs fluoroscopy). Twenty-one articles were used for the meta-analysis; however, the majority of these studies did not compare the same things.…”

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confidence: 99%

“…Wu et al concludes that bipolar radiofrequency ablation of the genicular nerves is more effective than monopolar ablation for improving pain and function in conventional and pulsed modalities. 4 There was, however, no direct comparison of pulsed bipolar versus monopolar radiofrequency ablation of the genicular nerves, only intra-articular radiofrequency ablation. This will need to be an area of further future study.…”

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confidence: 99%

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Editorial Commentary: Radiofrequency Ablation for Patients With Osteoarthritis of the Knee Could Be Indicated for Patients Failing Conventional Nonoperative Treatment and Wishing to Avoid Total Knee Arthroplasty

Lipnick

2022

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…A recent systematic review and meta-analysis evaluated different RFA modalities (cooled, pulsed, and conventional) and compared these treatments with other conservative therapies (eg, corticosteroid and hyaluronic acid intra-articular injections, platelet-rich plasma, nonsteroidal anti-inflammatory drugs, exercise). This study reported that RFA was effective at reducing both knee pain and improving function in patients with osteoarthritis.…”

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confidence: 99%