Intra-Articular hyaluronic acid injection versus RF ablation of genicular nerve for knee osteoarthritis pain: A randomized, open-label, clinical study

Ray, Debanjali; Goswami, Subrata; Dasgupta, Santi Ranjan; Ray, Subrata Basu; Basu, Sagarmay

doi:10.4103/ijpn.ijpn_2_18

Cited by 12 publications

(17 citation statements)

References 1 publication

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“…For knee osteoarthritis, in a review of systematic studies, genicular RFA was favored over intra-articular hyaluronic acid, intra-articular corticosteroid injection and combination intra-articular platelet-rich plasma and hyaluronic acid, in terms of pain and functional improvement between one and six months after treatment. [4,8,15,16] Genicular nerve RFA is a safe procedure with minimal complications. [7,12] The most common adverse effects reported are knee swelling, subcutaneous bruising, and sensitive alterations.…”

Section: Resultsmentioning

confidence: 99%

Genicular Nerve Radiofrequency Ablation Before Meniscal Transplant - A Case Report

Pinheiro¹,

Carvalho²,

Lopes³

et al. 2023

SVOAOR

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Case Description: A 47-year-old male with left knee pain after partial medial meniscectomy and arthroscopic chondral microfractures, was proposed for meniscal transplantation in 2019. Patient's knee pain was described as a moderate constant pain (6/10 in Visual Numeric Scale, VNS), with major interference in daily activity. Previous conservative treatment (physical therapy and oral analgesic medication) showed no substantial result. An intra-articular injection with hyaluronic acid and intra-articular of autologous platelet-rich plasma had also been performed without long term pain relief. Results:The patient underwent genicular nerve radiofrequency ablation (RFA), which resulted in long lasting pain relief. At six months of follow-up, patient reported a pain reduction, with VNS 0/10. Discussion: Genicular nerve RFA shows promising results in both pain reduction and functional improvement in patients with knee osteoarthritis. There is no data evaluating the efficacy of pain control before meniscal transplantation, with genicular nerve RFA. In our case, patient reported no pain after treatment and no need for analgesic treatment during this follow-up. Conclusion:Genicular nerve RFA seems to be a treatment option to fill the gap between conservative treatment and invasive surgery, even in patients with non-osteoarthritis related chronic knee pain.

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Section: Resultsmentioning

confidence: 99%

Genicular Nerve Radiofrequency Ablation Before Meniscal Transplant - A Case Report

Pinheiro¹,

Carvalho²,

Lopes³

et al. 2023

SVOAOR

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“…The composite outcome scores of WOMAC, Short Form-36, and GPE were used for geniculate nerve RFA treatment comparisons. Four high-quality RCTs 27,29,31,32 showed that geniculate nerve RFA had favorable outcomes for overall WOMAC and GPE scores when compared with IA HA, IA corticosteroids, conventional oral nonopioid analgesics, and sham procedures (Figure 4). One high-quality RCT 29 found geniculate nerve RFA to be markedly favored over IA corticosteroids at 1 month for WOMAC total but did not find a notable difference at 3 months (Figure 4).…”

Section: Resultsmentioning

confidence: 99%

“…30 All other studies reported zero treatment-related AEs. [27][28][29]31,32 Full data reporting and quality appraisals can be found in the Supplemental Data File (Supplemental Digital Content 1, http://links.lww.com/JAAOS/A517).…”

Section: Adverse Eventsmentioning

confidence: 99%

Thermal Nerve Radiofrequency Ablation for the Nonsurgical Treatment of Knee Osteoarthritis: A Systematic Literature Review

Chen

Mullen

Casambre

et al. 2021

J Am Acad Orthop Surg

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Background: There are roughly 14 million adults in the United States presenting with symptomatic osteoarthritis (OA) of the knee. Nerve radiofrequency ablation (RFA) is a nonsurgical procedure for the management of knee OA symptoms, and no previous systematic review has been performed comparing geniculate nerve RFA to other nonsurgical treatments. Questions/Purposes: (1) How does geniculate nerve RFA compare with other nonsurgical modalities for patients with knee OA about pain, function, quality of life, and composite scores? and (2) How does geniculate nerve RFA compare with other nonsurgical modalities for patients with knee OA about adverse events (AEs)? Methods: A systematic literature review was conducted within PubMed, EMBASE, and Cochrane Central Register of Controlled Trials to identify all studies from 1966 to 2019 evaluating the relative effectiveness of geniculate nerve thermal (heated or cooled) RFA compared with other nonsurgical treatments for knee OA. Two independent abstractors reviewed and analyzed the literature including comparators such as intra-articular (IA) corticosteroids, IA hyaluronic acid, NSAIDs, acetaminophen (paracetamol), and control/sham procedures. Inclusion was based on the following criteria: English language, human subjects, symptomatic knee OA, and patient-reported outcomes. Results: Five high-quality and two moderate-quality randomized controlled trials (RCTs) met the inclusion criteria for this review. The results showed consistent agreement across all RCTs in favor of geniculate nerve thermal RFA use for nonsurgical treatment of knee OA. One high-quality RCT and one moderate-quality RCT found geniculate nerve RFA to provide statistically significant outcome improvement compared with control or sham procedures regarding pain, function, quality of life, and composite scores. When compared with IA corticosteroids and hyaluronic acid, geniculate nerve RFA also provided notable improvement in pain, function, and composite scores (visual analog scale, Western Ontario, and McMaster Universities Arthritis Index, and Oxford Knee Score). RFA was markedly favored for all pain and composite outcomes (Western Ontario and McMaster Universities Arthritis Index and visual analog scale). The included RCTs did not report any serious AEs related to geniculate nerve RFA. Discussion: These results demonstrate geniculate nerve thermal RFA to be a superior nonsurgical treatment of knee OA compared with NSAIDs and IA corticosteroid injections. None of the RCTs reported any serious AEs with geniculate nerve thermal RFA, as opposed to known cardiovascular, gastrointestinal, and renal AEs for NSAIDs and accelerated cartilage loss and periprosthetic infection risk for IA corticosteroid injections. Level of Evidence: Level I

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“… 2 , 19 GNRFA has demonstrated notable efficacy and safety in the nonsurgical management of knee OA. 12 , 13 , 20 , 24 Cooled radiofrequency thermal ablation is an FDA-approved treatment of chronic moderate-to-severe knee pain caused by OA. High-quality RCTs have shown favorable outcomes with GNRFA knees when compared with IA HA, IA corticosteroids, standard oral nonopioid analgesics, and sham procedures.…”

Section: Discussionmentioning

confidence: 99%

“…High-quality RCTs have shown favorable outcomes with GNRFA knees when compared with IA HA, IA corticosteroids, standard oral nonopioid analgesics, and sham procedures. 13 , 20 , 22 , 24 At this time, the American Academy of Orthopaedic Surgeons Clinical Practice Guidelines endorse limited evidence in favor of denervation procedures for knee OA. 5 However, the effect of these procedures on complications and pain after TKA remains poorly understood.…”

Section: Discussionmentioning

confidence: 99%

Total Knee Arthroplasty After Genicular Nerve Radiofrequency Ablation: Reduction in Prolonged Opioid Use Without Increased Postsurgical Complications

Stake¹,

Agarwal²,

Coombs³

et al. 2022

JAAOS Glob Res Rev

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Introduction: Genicular nerve radiofrequency ablation (GNRFA) is an increasingly used nonsurgical treatment modality for patients with advanced knee osteoarthritis. Previous studies have demonstrated this to be an effective and safe method to decrease pain and increase functionality in this patient population. The purpose of this study was to compare 2-year postoperative complication rates and rates of prolonged postoperative opioid usage between patients undergoing total knee arthroplasty (TKA) after previous GNRFA and those undergoing TKA alone. Methods: Patients who underwent primary TKA after prior GNRFA (GNRFA-TKA) of the ipsilateral knee were identified in a national all-payer claims database from 2010 to 2019. Univariate and multivariable analyses were conducted comparing those with prior GNRFA and those without. Outcomes of interest included prolonged postoperative opioid usage, 2-year revision rates, and 90-day medical complications. Statistical analysis was conducted using R software provided by the PearlDiver Database. Results: In total, 675 patients in the GNRFA-TKA cohort were compared with a control cohort of 255,351 patients. Genicular nerve radiofrequency ablation-total knee arthroplasty patientshad lower odds of prolonged opioid use postoperatively (OR: 0.478; 95%: 0.409 to 0.559; P < 0.001). No notable difference was observed in the 2-year surgical outcomes between cohorts. Patients in the GNRFA-TKA cohort had lower odds of requiring a blood transfusion and having postoperative anemia, all arrhythmias, and urinary infections compared with primary TKA control patients. Conclusion: Preoperative GNRFA leads to a lower rate of prolonged postoperative opioid use in patients undergoing TKA, without an increased risk of complications. Future prospective studies are needed to validate the findings of this database study.

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Intra-Articular hyaluronic acid injection versus RF ablation of genicular nerve for knee osteoarthritis pain: A randomized, open-label, clinical study

Cited by 12 publications

References 1 publication

Genicular Nerve Radiofrequency Ablation Before Meniscal Transplant - A Case Report

Genicular Nerve Radiofrequency Ablation Before Meniscal Transplant - A Case Report

Thermal Nerve Radiofrequency Ablation for the Nonsurgical Treatment of Knee Osteoarthritis: A Systematic Literature Review

Total Knee Arthroplasty After Genicular Nerve Radiofrequency Ablation: Reduction in Prolonged Opioid Use Without Increased Postsurgical Complications

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