A pilot study comparing the efficacy of radiofrequency and microwave diathermy in combination with intra-articular injection of hyaluronic acid in knee osteoarthritis

Abstract

[Purpose] This study aimed to compare the efficacy of radiofrequency diathermy with that of microwave diathermy in combination with intra-articular injection of hyaluronic acid into the knee of patients with osteoarthritis (OA). [Subjects] A total of 17 patients with knee OA were enrolled. The participants were randomly divided into two groups: a radiofrequency diathermy group (RF group, 9 subjects), and a microwave diathermy group (MW group, 8 subjects). [Methods] Subjects received radiofrequency or microwave thermal therapy 3 times at 1-week intervals. Intra-articular injection of hyaluronic acid was administered 10 min before every thermal therapy session. The outcome was evaluated using the Japan Orthopaedic Association (JOA) and the Lequesne Index (LI) at baseline, at weeks 1 (1 week after the first thermal therapy) and 3 (1 week after the last thermal therapy). [Results] The JOA scale increased significantly after three sessions of thermal therapy in the RF group, while no significant increase was observed in the MW group. LI decreased significantly after 3 weeks in the RF group. In the MW group, there was no significant difference in LI between the two time points. [Conclusion] This study revealed that symptom relief in patients with knee OA was greater with radiofrequency diathermy than with microwave diathermy with concurrent use of hyaluronic acid injection, presumably due to the different heating characteristics of the two methods.

Comparative Effectiveness Review of Cooled Versus Pulsed Radiofrequency Ablation for the Treatment of Knee Osteoarthritis: A Systematic Review

“…These currently published studies make it difficult to compare the effectiveness of radiofrequency ablation between the 3 different procedure types. All of the published studies (6,8,12,(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) in this review report positive patient outcomes regardless of the type of ablation procedure used. Clendenen et al (20) were the only authors to report a result of less than significant pain relief following a conventional RFA procedure, which occurred in one of the 2 patients receiving ablation in the study.…”

“…With the Medline and CEN-TRAL searches and review of references, a total of 17 studies were considered for this review. The degree of evidence regarding the efficacy of radiofrequency ablation in the literature was not substantially high -only 5 small-sized randomized controlled trials were identified with size ranging from 17 to 54 patients (6,8,(14)(15)(16). The remaining studies were retrospective (17)(18)(19)(20) and prospective (21)(22)(23)(24) observational case series and case reports (12,(25)(26)(27).…”

“…Of the 6 studies analyzing conventional RFA (6,8,12,14,15,20), 4 studies do not mention any adverse event reporting (6,12,15,20), one study mentions that no adverse events were reported (8), and one study (with an N = 35) reports that 67% of patients experienced minor subcutaneous bleeding at the injection site and 78% reported prolonged hypoesthesia (14). Of the 4 studies analyzing CRF (16,19,26,27), 3 studies mentioned that there were no adverse events reported (19,26,27) and one study did not mention any adverse event reporting (16). Of the 7 studies analyzing PRF (17,18,(21)(22)(23)(24)(25), 6 studies mentioned that no adverse events were reported (17,18,(21)(22)(23)(24) and one study did not mention any adverse event reporting (25).…”

“…Four publications utilized ultrasound guidance during the ablation procedure, 3 of which utilized PRF (21,22,24) while Clendenen et al (20) utilized conventional RFA and Protzman et al (12) applied both methodologies during a conventional RFA procedure. Meanwhile, the other 5 studies (6,(14)(15)(16)18) did not use any imaging, but simply used physical exam landmarks or failed to clearly specify whether imaging was or was not used. Kesikburun et al (24) performed ultrasound-guided PRF targeting the genicular nerves on 9 patients.…”

“…Of the 5 studies analyzed that were controlled intervention studies, 4 did not utilize any imaging modality (Shen et al [6], Alcidi et al [15], Ikeuchi et al [14], and Takahashi et al [16]). While the studies that report using imaging guidance, whether fluoroscopy or ultrasound, tend to report positive outcomes, it is difficult to make a statement about the necessity of imaging in RFA.…”