Ultrasound-guided genicular nerve block versus physical therapy for chronic knee osteoarthritis: a prospective randomised study

Abstract

To compare the effectiveness of ultrasound-guided genicular nerve block (GNB) and physical therapy (PT) in patients with chronic knee osteoarthritis. A prospective randomised study with 102 patients (45-70 years) was performed wherein the patients received ultrasound-guided GNB (n = 51) and PT (n = 51) along with a standard home exercise programme. Scores for pain on a Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and 6-min walking test (6MWT) were assessed pre-treatment and at 2-and 12-weeks post-treatment. Both groups were comparable for sociodemographic characteristics. VAS scores (in mm) in the ultrasound-guided GNB group at 0, 2 and 12 weeks were 7.01 ± 1.36; 3.71 ± 2.18; 5.08 ± 2.22 (p < 0.001) and 6. 64 ± 1.99; 4.35 ± 1.09; 5.25 ± 1.33, (p < 0.001) in the PT group. While the increase in the 6MWT test in the 2nd week was similar for both groups (p = 0.073), the increase in walking distance was greater in the ultrasound-guided GNB group at 12 weeks (p = 0.046). As compared to PT, ultrasound-guided GNB is beneficial in reducing pain and increasing functional and physical capacity, with greater retention of effects on the physical capacity seen at 12 weeks. Trial registration number: ClinicalTrials.gov (NCT04782401).

Short- and mid-term clinical results of ultrasound-guided genicular nerve block in arthroplasty-related chronic postsurgical pain

“…Improvement in pain severity as measured by NRS and functionality as assessed by WOMAC was demonstrated at a 3-month follow-up (22). Guler et al (23) showed that ultrasound-guided genicular nerve blockade with a total mixture of 5 ml of 2% lidocaine and 40 mg of triamcinolone, to patients with knee osteoarthritis has sustained improvement in pain, physical function, and physical capacity for up to 12 weeks. Fonkoue et al (24) performed a single session genicular nerve blockade with a mixture of lidocaine and triamcinolone, using scopy-controlled classic and revised target techniques, to patients with chronic knee pain due to osteoarthritis.…”

Effects of externally-applied, non-pharmacological Interventions on short- and long-term symptoms and inflammatory cytokine levels in patients with knee osteoarthritis: a systematic review and network meta-analysis

“…Concerns regarding the safety and bottlenecking of drug treatments have increased the focus on non-drug therapies. Non-drug treatments for KOA have the advantages of significantly higher efficacy, lasting effects, and few adverse reactions, and have become a hot research topic in recent years ( 11 , 12 ). Several guidelines and consensuses ( 13 – 15 ) list non-drug therapies as recommended interventions for the clinical treatment of KOA.…”

Can ultrasound-guided radiofrequency ablation of genicular nerves of the knee, be performed without locating corresponding arterial pulsations—a cadaveric study

“…There are different approaches prevailing for targeting this nerve. Conventionally, the bony cortex near the corresponding artery at the shaft and medial epicondyle junction is used as the landmark for targeting this nerve [ 24 , 35 – 39 ]. The junction of the shaft and medial epicondyle of the femur in the coronal plane and half of the depth of the femur in the axial view is also used [ 40 ].…”

“…[ 30 , 45 ] Even though there is variation in origin, the distal course is constant [ 41 ]. Conventionally, the nerve is targeted at the bony cortex, near the corresponding artery, over the junction of the shaft and lateral femoral epicondyle [ 24 , 35 – 39 , 42 , 44 ]. Recently described techniques include, targeting the superolateral popliteal fossa, medial to biceps femoris tendon, around 2.6 cm proximal to the most prominent part of the lateral femoral epicondyle visualized under ultrasound [ 46 ], or locating the junction of the shaft and lateral epicondyle of the femur in the coronal plane and to target either half of the depth of femur in axial view [ 32 , 40 ] or the crest separating lateral and posterior cortex, in axial view [ 43 ].…”

“…The IMGN was described as arising from the tibial nerve in the popliteal fossa and curving around the tibia to emerge anteriorly, deep to the medial collateral ligament, at the midpoint between the most prominent part of the medial tibial condyle and the medial collateral ligament's (MCL) initial insertion [ 1 , 30 , 32 – 34 , 41 , 47 ]. Conventionally, it is targeted at the junction of the medial tibial condyle and shaft in the coronal plane and half the girth of the tibia in the axial plane [ 32 , 43 , 48 ] and near the corresponding artery [ 24 , 35 – 40 ]. Another technique is to target half the distance between the most prominent part of the medial tibial condyle and the insertion of deep fibers of the medial collateral ligament visualized under ultrasound [ 33 , 34 ].…”