SIR 2024
Pain Management/MSK
Ashkan Heshmatzadeh Behzadi, MD (he/him/his)
Vascular and Interventional Radiology Resident
University of Minnesota
Financial relationships: Full list of relationships is listed on the CME information page.
This Systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A search of databases was conducted until August 1, 2023. The studies included were prospective clinical trials of fluoroscopically guided genicular nerve RFA. The primary outcome was the proportion of individuals with 50% or greater pain reduction at 6 to 24 months post-procedure compared with baseline, using validated self-report rating scales, such as the Numeric Rating Scale (NRS) or Visual Analog Scale (VAS). Secondary outcomes included improvement in disability as assessed by the Western Ontario and McMaster Universities Osteoarthritis Index or Oxford Knee Score.
Results:
261 publications were screened, and 12 studies were included with a total number of 760 participants. Six-month, 18-month, and 24-month success rates for 50% or greater pain relief after radiofrequency ablation ranged from 49% to 81%, ranging from 50% to 69% and ranging from 48% to 61% respectively. Present data showed functional, and quality of life improvements persisted similarly, with mean changes from baseline of 53.5% and 34.9% in WOMAC total scores. Additionally, functional improvement as measured by the Oxford Knee Score continued to be present, with an overall mean change from baseline of 26.0±9.6 points at 18 months and 29.9 ± 10.4 points at 24 months.
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 = 2.7-8.00). When radiofrequency ablation was compared with hyaluronic acid injection, the probability of treatment success was 1.8 times higher (relative risk = 1.9, 95% confidence interval = 1.4-2.6).
Conclusion:
This systematic review revealed that fluoroscopically guided genicular radiofrequency ablation is an effective and safe method for pain relief and improved function in the short and long term (6 months to 24 months) for subjects with OA knee pain with no safety concerns identified.
Based on a limited number of studies, it seems superiority of genicular radiofrequency ablation to medical management, Intra-Articular Steroid Injection, and Hyaluronic Acid Injection.