The Effectiveness of Fluoroscopically Guided Genicular Nerve Radiofrequency Ablation for the Treatment of Chronic Knee Pain Due to Osteoarthritis

Abstract

The objective was to determine the effectiveness of fluoroscopically guided genicular nerve radiofrequency ablation for painful knee osteoarthritis. Primary outcome measure was improvement in pain after 6 mos. Secondary outcomes included the Oxford Knee Score and Western Ontario and McMaster Universities Osteoarthritis Index. Two reviewers independently assessed publications before October 10, 2020. The Cochrane Risk of Bias Tool and Grades of Recommendation, Assessment, Development, and Evaluation system were used. One hundred ninety-nine publications were screened, and nine were included. Six-month success rates for 50% or greater pain relief after radiofrequency ablation ranged from 49% to 74%. When compared with intra-articular steroid injection, the probability of success was 4.5 times higher for radiofrequency ablation (relative risk = 4.58 [95% confidence interval = 2.61–8.04]). When radiofrequency ablation was compared with hyaluronic acid injection, the probability of treatment success was 1.8 times higher (relative risk = 1.88, 95% confidence interval = 1.38–2.57). The group mean Oxford Knee Score and Western Ontario and McMaster Universities Osteoarthritis Index scores improved in participants receiving genicular radiofrequency ablation compared with intra-articular steroid injection and hyaluronic acid injection. According to Grades of Recommendation, Assessment, Development, and Evaluation, there is moderate-quality evidence that fluoroscopically guided genicular radiofrequency ablation is effective for reducing pain associated with knee osteoarthritis at minimum of 6 mos. Further research is likely to have an important impact on the current understanding of the long-term effectiveness of this treatment.

Comparison of the efficacy of genicular nerve phenol neurolysis and radiofrequency ablation for pain management in patients with knee osteoarthritis

“…In a double-blind, randomized controlled study by Choi et al [ 5 ], the 50% success rate with genicular RFA was 59% at three months. In a systematic review evaluating the efficacy of genicular RFA, at least 50% success rates at six months were reported to be between 49% and 74% [ 9 ].…”

Upper limb and lower limb radiofrequency treatments in orthopaedics

“…The group mean OKS and WOMAC scores improved in the individuals experiencing genicular RF compared with intra-articular steroid injection and hyaluronic acid injection. This study showed moderate-quality evidence that fluoroscopically guided genicular RF was effective for relieving pain associated with knee OA at a minimum of 6 months ( 56 ).…”

What’s New in Orthopaedic Rehabilitation

“…Genicular nerve radiofrequency ablation (RFA) is a conservative pain management technique used to treat chronic knee pain. In a systematic review, Fogarty et al reported moderate-quality evidence for use of fluoroscopically guided genicular RFA for chronic knee pain 11 . Genicular RFA provided 49% to 74% of patients with ≥50% pain relief and was more likely to be successful than intra-articular corticosteroid injections or hyaluronic acid injections at the 6-month follow-up.…”