Fluoroscopy -guided genicular nerves pulsed radiofrequency for chronic knee pain treatment

Abstract

Objectives: The primary objective of this study was to investigate the effects of Pulsed RF application in the genicular nerve on pain and function in patients with osteoarthritis (OA) and its side effects. Methods: This study was conducted between February 2018 and June 2018. Patients who were previously administered diagnostic blocks were evaluated a day later; a drop of at least 50% in numeric pain scores was considered a positive response, and these patients were included in the Pulsed RF neurotomy procedures. Radiofrequency (RF) cannula was advanced towards targeted nerves under the guidance of fluoroscopy. RF lesions were created by applying Pulsed RF treatment to the three genicular nerves three times with five minutes intervals at 42 °C using NT1000 RF Generator. Following the Pulsed RF application, 2 mL 0.5% bupivacaine was injected into each genicular nerve as an anesthetic agent. VAS, pain DETECT scores, WOMAC scores were evaluated preoperative baseline and postprocedure weeks 1, 4, and 12. Patient Global Impression of Change (PGIC) score was evaluated postprocedure weeks 12. Results: This study included 20 patients who were administered genicular nerve Pulsed RF. The mean age was 55.2±3.24 years, and F/M ratio was 12/8. Compared to the pre-procedure period, patients' pain and function evaluation, WOMAC and VAS values decreased by approximately 50% at the end of the 12th week. No side effect was observed in any patients. Conclusion: Our findings suggest that Pulsed RF neurotomy of the genicular nerves is an efficient and safe treatment method for patients with chronic knee osteoarthritis.

Pulsed Radiofrequency Rhizotomy of the Genicular Nerves of the Knee Guided by Radioscopy and Ultrasonography: Step-By-Step Technique

“…8 They reported superiority of the use of CFR in the rate of pain reduction more significant than 50% at the assessment after 6 months (CFR 71% vs HA 38%; P < .001), in the WOMAC score at 6 months (48.2 CFR vs 22.6% AH; P < .001), and in the improvement to the perception of global improvement score at 6 months (72 CFR vs 40% HA; P < .01). 8 In 2020, Arıcan et al 9 published a study analyzing 20 patients with knee OA equal to or greater than KellgreneLawrence II submitted to pulsed RF. All analyzed patients were previously submitted to a test block with anesthetic of the genicular nerves, being included in the study only if the pain improved by at least 50% after the test block.…”

“…They concluded that pulsed RF of the genicular nerves is a safe and effective technique for patients with chronic OA of the knee. 9 Elawamy et al 10 carried out a prospective randomized study comparing pain improvement, analyzed by the VAS questionnaire, between patients with Kellgrene Lawrence III or IV OA between 2 groups of 100 patients each. Group I underwent pulsed RF in the genicular nerves guided only by ultrasound, and group II underwent intra-articular injection of platelet-rich plasma into the affected knee, also guided by ultrasound.…”

“…In 2020, Arıcan et al. 9 published a study analyzing 20 patients with knee OA equal to or greater than Kellgren–Lawrence II submitted to pulsed RF. All analyzed patients were previously submitted to a test block with anesthetic of the genicular nerves, being included in the study only if the pain improved by at least 50% after the test block.…”

“…They concluded that pulsed RF of the genicular nerves is a safe and effective technique for patients with chronic OA of the knee. 9 …”

Radiofrecuencia de los nervios geniculados para el tratamiento del dolor crónico en la osteoartrosis de rodilla

“…Encontramos estudios que usan radiofrecuencia pulsada (RFP) a 42°C durante 5 minutos en cada nervio geniculado con buenos resultados, disminuyendo el valor de la escala WOMAC y de la EVA, sin complicaciones o efectos secundarios (37,38). Este tipo de RF tiene la ventaja de no producir una lesión nerviosa que pueda llevar a artropatía neuropática o articulación de Charcot y dolor neuropático secundario; siendo recomendada en la población que no presente una gonartrosis muy avanzada.…”