Safety and Efficacy of Genicular Nerve Radiofrequency Ablation for Management of Painful Total Knee Replacement: A Systematic Review

Cheppalli, Naga Suresh; Bhandarkar, Amit Wasudeo; Sambandham, Senthil; Oloyede, Solomon F.

doi:10.7759/cureus.19489

Cited by 7 publications

(6 citation statements)

References 52 publications

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“…While the literature reports occurrences of this event after arthroscopy, bone biopsy, osteotomy, and traumatic injuries, we found no reports of synovial fistulae following a genicular nerve ablation procedure. [8][9][10] A synovial fistula is a channel of congenital, iatrogenic, or ulcerative origin sustained by the continuous production and leakage of synovial fluid from the joint to the skin in a unidirectional and centrifugal way. Concerning symptoms are pain, inflammation, loss of function, and continuous fluid leakage.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Treatment of Post-Radiofrequency Synovial Knee Fistula: Case Report

Rocha-Romero

2023

A&A Practice

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Recently, denervation therapies have drawn attention as a promising treatment, and cooled radiofrequency has been proposed as the best option to capture most of the genicular nerves. We present a rare case of synovial knee fistula after radiofrequency and its management. To the best of our knowledge, this is the first case reported in the literature. The treatment included immobilization and chemoprophylaxis. One week later, the fistula was closed, and 14 months later, the procedure was repeated without complications. Genicular radiofrequency ablation is an emerging technique, and providers should be aware of the reported complications to counsel patients and manage potential risks appropriately.

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Section: Discussionmentioning

confidence: 99%

Diagnosis and Treatment of Post-Radiofrequency Synovial Knee Fistula: Case Report

Rocha-Romero

2023

A&A Practice

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“…[24][25][26][27] At the moment, literature on RF for knee PPSP is scarcer. 28 Furthermore, retrospective and pilot studies indicate a possible larger effectivity of cooled RF compared with conventional RF on knee pain. However, these have not been directly compared in powered prospective studies in both the OA and PPSP population.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

“…Recent systematic reviews report that conventional RF treatment of the genicular nerves is an effective, well-tolerated and safe procedure in knee OA 24–27. At the moment, literature on RF for knee PPSP is scarcer 28. Furthermore, retrospective and pilot studies indicate a possible larger effectivity of cooled RF compared with conventional RF on knee pain.…”

Section: Introductionmentioning

confidence: 99%

Comparison of conventional and cooled radiofrequency treatment of the genicular nerves versus sham procedure for patients with chronic knee pain: protocol for a multicentre, double-blind, randomised controlled trial (COGENIUS)

et al. 2023

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IntroductionThe prevalence of chronic knee pain is increasing. Osteoarthritis (OA) and persistent postsurgical pain (PPSP) are two important causes of knee pain. Chronic knee pain is primarily treated with medications, physiotherapy, life-style changes and intra-articular infiltrations. A radiofrequency treatment (RF) of the genicular nerves is a therapeutical option for refractory knee pain. This study investigates the effectiveness and cost-effectiveness of conventional and cooled RF in patients suffering from chronic, therapy resistant, moderate to severe knee pain due to OA and PPSP.Methods and analysisThe COGENIUS trial is a double-blinded, randomised controlled trial with 2-year follow-up. Patients and outcome assessors are blinded. Patients will be recruited and treated in Belgium and the Netherlands. All PPSP after a total knee prothesis and OA patients (grades 2–4) will undergo a run-in period of 1–3 months where conservative treatment will be optimised. After the run-in period, 200 patient per group will be randomised to conventional RF, cooled RF or a sham procedure following a 2:2:1 ratio. The analysis will include a comparison of the effectiveness of each RF treatment with the sham procedure and secondarily between conventional and cooled RF. All comparisons will be made for each indication separately. The primary outcome is the Western Ontario and McMaster Universities Osteoarthritis Index score at 6 months. Other outcomes include knee pain, physical functionality, health-related quality of life, emotional health, medication use, healthcare and societal cost and adverse events up to 24 months postintervention.Ethics and disseminationEthics approval was obtained from the Ethics Committee of the University of Antwerp (Number Project ID 3069-Edge 002190-BUN B3002022000025), the Ethics committee of Maastricht University (Number NL80503.068.22-METC22-023) and the Ethics committee of all participating hospitals. Results of the study will be published in international peer-reviewed journals.Trial registration numberNCT05407610.

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“…Genicular nerve radiofrequency ablation (GNRFA) has gained interest as an analgesic modality in TKA. GNRFA was initially used to treat pain associated with osteoarthritis, but now the range of indications has widened to include pain control for perioperative TKA patients and for chronically painful well-appearing TKA [ 6 , 15 ]. While the topic has been gaining recent traction, a summary of the available literature that highlights the current state of the intervention and potential for improvement remains lacking.…”

Section: Introductionmentioning

confidence: 99%

“…While TKA is considered a successful and cost-effective treatment modality, there remains potential for improvement in the satisfaction rates following the procedure [3][4][5]. As many as 20-30% of patients express a lack of satisfaction with the outcomes following TKA [1], with major cited factors including incomplete pain resolution or restoration of function with continued low mobility or stiffness [2,3,6]. While the etiology of dissatisfaction is multifactorial and remains poorly understood, postoperative pain constitutes a commonly cited variable [2,4,7,8].…”

Section: Introductionmentioning

confidence: 99%

Genicular nerve radiofrequency ablation: a systematic review of application for perioperative pain control in total knee arthroplasty and as treatment for chronic pain in well-appearing total knee arthroplasty

Nnake,

El-Othmani,

Cooper

et al. 2024

Knee Surg & Relat Res

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Background Total knee arthroplasty (TKA) is a successful treatment for end-stage osteoarthritis, yet some patients still experience postoperative pain. Genicular nerve radiofrequency ablation (GNRFA) has become a potential modality to address pain in TKA. This systematic review aims to critically analyze the applicability of GNRFA in perioperative pain control prior to TKA, as well as a treatment modality for chronic painful well-appearing TKA. Methods PubMed, Medline, EMBASE, Google Scholar, Scopus, and COCHRANE databases, as well as the ClinicalTrials.gov register, were reviewed. The search included randomized controlled trials and cohort studies. The sample population focused on two cohorts; those who underwent TKA and utilized intentional GNRFA as a perioperative pain control modality, and those utilizing the treatment modality for chronic pain in well-appearing TKA. GNRFA was the intervention studied, and postoperative outcomes were compared with the control group, which consisted of those not receiving GNRFA. Result Eight total publications were identified as relevant to this search. Among the pre-TKA studies, there was variability in results; these inconsistencies were attributed to a lack of standardization, especially with regard to type, timing, and targeted nerves with ablation. Likewise, while the results were improved among the population with chronic painful TKA receiving GNRFA, these inconsistencies still existed. Conclusions Current evidence suggests GNRFA as a possible pre-TKA intervention to potentially minimize opioid consumption, patient-reported pain, length of stay, and increased range of motion and activity. However, the short-lived duration in the setting of chronically painful well-appearing TKA represents a major barrier that warrants further investigation. Limitations include small sample size, heterogeneity, lack of standardization of techniques among studies, and lack of direct comparison and meta-analysis. Further research should focus on the standardization of technique as well as analyzing various patient and health-system-related factors that correlate with sustained positive outcomes.

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Safety and Efficacy of Genicular Nerve Radiofrequency Ablation for Management of Painful Total Knee Replacement: A Systematic Review

Cited by 7 publications

References 52 publications

Diagnosis and Treatment of Post-Radiofrequency Synovial Knee Fistula: Case Report

Diagnosis and Treatment of Post-Radiofrequency Synovial Knee Fistula: Case Report

Comparison of conventional and cooled radiofrequency treatment of the genicular nerves versus sham procedure for patients with chronic knee pain: protocol for a multicentre, double-blind, randomised controlled trial (COGENIUS)

Genicular nerve radiofrequency ablation: a systematic review of application for perioperative pain control in total knee arthroplasty and as treatment for chronic pain in well-appearing total knee arthroplasty

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