Radiofrequency treatment relieves chronic knee osteoarthritis pain: A double-blind randomized controlled trial

Abstract

Chronic osteoarthritis (OA) pain of the knee is often not effectively managed with current non-pharmacological or pharmacological treatments. Radiofrequency (RF) neurotomy is a therapeutic alternative for chronic pain. We investigated whether RF neurotomy applied to articular nerve branches (genicular nerves) was effective in relieving chronic OA knee joint pain. The study involved 38 elderly patients with (a) severe knee OA pain lasting more than 3 months, (b) positive response to a diagnostic genicular nerve block and (c) no response to conservative treatments. Patients were randomly assigned to receive percutaneous RF genicular neurotomy under fluoroscopic guidance (RF group; n=19) or the same procedure without effective neurotomy (control group; n=19). Visual analogue scale (VAS), Oxford knee scores, and global perceived effect on a 7-point scale were measured at baseline and at 1, 4, and 12weeks post-procedure. VAS scores showed that the RF group had less knee joint pain at 4 (p<0.001) and 12 (p<0.001) weeks compared with the control group. Oxford knee scores showed similar findings (p<0.001). In the RF group, 10/17 (59%), 11/17 (65%) and 10/17 (59%) achieved at least 50% knee pain relief at 1, 4, and 12 weeks, respectively. No patient reported a post-procedure adverse event during the follow-up period. RF neurotomy of genicular nerves leads to significant pain reduction and functional improvement in a subset of elderly chronic knee OA pain, and thus may be an effective treatment in such cases. Further trials with larger sample size and longer follow-up are warranted.

Cooled radiofrequency system relieves chronic knee osteoarthritis pain: the first case-series

“…Raadiofrequency neurotomy is used successfully in OA patients [8]: Choi et al [5] investigated the use of RF treatment to alleviate chronic knee osteoarthritis pain. The randomised controlled trial demonstrated greater improvements in pain, function, and satisfaction for patients treated with RF than for controls.…”

“…As a result, larger spherical-shaped lesions are produced that accomplish an effective denervation [5]. No one has studied the effect of cooled radiofrequency on genicular nerves: we examined the efficacy of this application to sensory nerves as a novel alternative treatment for refractory knee pain.…”

Radiofrequency Thermocoagulation, a New Alternative Therapy for Genicular Nerves in Chronic Knee Osteoarthritis: A Pilot Study

“…[10] 2011 yılında yaptıkları randomize kontrollü çalışma ile geniküler sinire RF uygulamasının kronik diz OA ağrısı üzerine etkili olduğunu göstermişlerdir. Aynı yıl yayınlanan Ikeuchi ve ark.nın [20] yaptıkları duyusal sinirlere yönelik RF uygulamasının, ağrı üzerine etkinliğini değerlendirdikleri kontrollü çalışmada, uygulamadan 12 hafta sonra hastaların ağrı şiddeti-nin kontrol grubuna kıyasla azaldığı belirtilmiştir.…”

“…Diz eklemi sinirlerine radyofrekans termokoagülasyon (RFT) yöntemi ile nörotomi yapılması OA ağrı tedavisinde alternatif yöntem olarak ilk kez 2011 yılında Choi ve ark. [10] tarafından tanımlanmıştır. Diz eklemi geniküler sinirler olarak bilinen; femoral, peroneal, safen, tibial ve obturator sinirler tarafından inerve edilmektedir.…”

“…[11] Literatürde diz OA ağrısı için diz geniküler sinire RF uygulamasının etkinliğini değerlendiren sadece bir çalışmaya rastladık. [10] Çalışmamızda primer olarak geniküler sinire RF uygulamasının diz OA hastalarında klinik ve fonksiyonel durum üzerine etkisini araştırmayı amaçladık.…”