Interventional procedure overview of radiofrequency denervation for osteoarthritic knee pain

Article

Number of patients and follow up

Direction of conclusions

Reason study was not included in main evidence summary

Ajrawat P, Radomski L, Bhatia A et al. (2020) Radiofrequency Procedures for the Treatment of Symptomatic Knee Osteoarthritis: A Systematic Review. Pain medicine (Malden, Mass.) 21(2):333-48

Systematic review

n=33 studies

Current evidence substantiates that RF modalities for knee OA potentially improve pain, functionality, and disease-specific QOL for up to three to 12 months with minimal localized complications. This suggests that RF modalities are perhaps an effective adjunct therapy for patients with knee OA who are unresponsive to conservative therapies. Further RCTs with larger sample sizes and long-term follow-up that directly compare the three primary RF modalities are warranted to confirm the clinical efficaciousness and superiority of these RF modalities for knee OA.

More recent systematic reviews included.

Akbas M, Luleci N, Dere K et al. (2011) Efficacy of pulsed radiofrequency treatment on the saphenous nerve in patients with chronic knee pain. Journal of back and musculoskeletal rehabilitation 24(2):77-82

Case series

n=115

FU=22 months

PRF application to the saphenous nerve for eight minutes showed remarkable amount of patient satisfaction. Application of PRF for the second time could be recommended if it shows some benefit after the sixth month. But none of our patients needed a second application of PRF after six months period.

Studies with more patients or longer follow up included.

Burgos LA, Greenwood AJ, Tarima SS, et al. (2021) Pain relief following genicular nerve radiofrequency ablation: does knee compartment matter?. Pain management 11(6):705-714.

Case series

n=62

FU=6 months

Compartmental location of knee OA impacts pain relief following genicular radiofrequency ablation. Future protocols could target nerves based on which compartments are more affected on imaging.

Studies with more patients or longer follow up included.

Carlone AG, Grothaus O, Jacobs C, and Duncan ST. (2021) Is Cooled Radiofrequency Genicular Nerve Block and Ablation a Viable Option for the Treatment of Knee Osteoarthritis? Arthroplasty Today 7:220-224

Case series

n=176

FU=6 weeks

Cooled RFA may be an effective adjunct therapy as part of a multimodal pain regimen; however, individual patient characteristics must be considered.

Studies with more patients or longer follow up included.

Carpenedo R, Al-Wardat M, Vizzolo L, et al. (2022) Ultrasound-guided pulsed radiofrequency of the saphenous nerve for knee osteoarthritis pain: a pilot randomized trial. Pain management 12(2):181-193.

Pilot RCT

n=20 (10 PRF; 10 sham)

FU=6 months

PRF of the saphenous nerve is an alternative to relieve pain in gonarthritis. Our results provide data to support a sample size calculation for future trials.

RCTs with more patients included in systematic reviews.

Chen AF, Mullen K, Casambre F et al. (2021) Thermal Nerve Radiofrequency Ablation for the Nonsurgical Treatment of Knee Osteoarthritis: A Systematic Literature Review. The Journal of the American Academy of Orthopaedic Surgeons 29(9):387-96

Systematic review

n=7 studies

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.

More recent meta-analyses included.

Chen AF, Khalouf F, Zora K et al. (2020) Cooled radiofrequency ablation provides extended clinical utility in the management of knee osteoarthritis: 12-month results from a prospective, multi-center, randomized, cross-over trial comparing cooled radiofrequency ablation to a single hyaluronic acid injection. BMC musculoskeletal disorders 21(1):363

RCT

n=175 (88 Cooled RF; 87 control)

FU=12 months

A majority of subjects treated with CRFA demonstrated sustained knee pain relief for at least 12-months. Additionally, CRFA provided significant pain relief for HA subjects who crossed over 6 months after treatment.

Captured in the Wu, 2022 network meta-analysis.

Chen AF, Khalouf F, Zora K, et al. (2020) Cooled Radiofrequency Ablation Compared with a Single Injection of Hyaluronic Acid for Chronic Knee Pain: A Multicenter, Randomized Clinical Trial Demonstrating Greater Efficacy and Equivalent Safety for Cooled Radiofrequency Ablation. The Journal of bone and joint surgery American volume 102(17):1501-1510.

RCT

n=175 (88 Cooled RF; 87 control)

FU=6 months

CRFA-treated subjects demonstrated a significant improvement in pain relief and overall function compared with subjects treated with a single injection of HA. No serious adverse events related to either procedure were noted, and the overall adverse-event profiles were similar.

Captured in the Wu, 2022 network meta-analysis.

Choi WJ, Hwang SJ, Song JG, et al. (2011) Radiofrequency treatment relieves chronic knee osteoarthritis pain: a double-blind randomized controlled trial. Pain 152(3):481-487.

RCT

n=38 (19 RF; 19 sham)

FU=12 weeks

RF neurotomy of genicular nerves leads to significant pain reduction and functional improvement in a subset of elderly chronic knee OA pain, and thus may be an effective treatment in such cases. Further trials with larger sample size and longer follow-up are warranted.

Captured in the Wu, 2022 network meta-analysis.

Davis T, Loudermilk E, Depalma M et al. (2019) Twelve-month analgesia and rescue, by cooled radiofrequency ablation treatment of osteoarthritic knee pain: Results from a prospective, multicenter, randomized, cross-over trial. Regional Anesthesia and Pain Medicine 44(4):499-506

RCT

n=151 (76 cooled RF; 75 sham)

FU=12 months

This study demonstrates that analgesia following cooled RFA for OA knee pain could last for at least 12 months and could rescue patients who continue to experience intolerable discomfort following IAS.

Captured in the Wu, 2022 network meta-analysis.

Davis T, Loudermilk E, DePalma M et al. (2018) Prospective, Multicenter, Randomized, Crossover Clinical Trial Comparing the Safety and Effectiveness of Cooled Radiofrequency Ablation With Corticosteroid Injection in the Management of Knee Pain From Osteoarthritis.

Regional anesthesia and pain medicine 43(1):84-91

RCT

n=151 (76 cooled RF; 75 sham)

FU=6 months

This study demonstrates that cooled RFA is an effective long-term therapeutic option for managing pain and improving physical function and quality of life for patients with painful knee OA when compared with IAS injection

Captured in the Wu, 2022 network meta-analysis.

El-Hakeim EH, Elawamy A, Kamel EZ, et al. (2018) Fluoroscopic Guided Radiofrequency of Genicular Nerves for Pain Alleviation in Chronic Knee Osteoarthritis: A Single-Blind Randomized Controlled Trial. Pain physician 21(2):169-177.

RCT

n=60 (30 RF; 30 control)

FU=6 months

RF can ameliorate pain and disability in chronic knee osteoarthritis in a safe and effective manner.

Captured in the Chou, 2021 meta-analysis.

El-Tamboly S, Medhat M, Khattab R, et al. (2021). Pulsed radiofrequency ablation of genicular nerve versus intra-articular radiofrequency ablation combined with platelets rich plasma for chronic kneeosteoarthritis. Egyptian Journal of Anaesthesia 37(1):317-325.

RCT

n=60

FU=12 months

The use of ultrasonography intra-articular-platelet-rich plasma injection combined to pulsed radiofrequency ablation of articular surface show significant improvement in pain compared to the genicular nerve.

RCTs with more patients or longer follow up included.

Elemam EM, Abdel Dayem OT, Mousa SA, Mohammed HM. (2022) Ultrasound-guided monopolar versus bipolar radiofrequency ablation for genicular nerves in chronic knee osteoarthritis pain: A randomized controlled study. Annals of Medicine and Surgery 77:103680.

RCT

n=50 (25 monopolar; 25 bipolar)

FU=24 weeks

Ultrasound guided bipolar RF ablation is more effective than monopolar RF ablation in controlling knee osteoarthritis pain as for the duration and severity of pain without fluoroscopic confirmation.

RCTs with more patients or longer follow up included.

Elawamy A, Kamel EZ, Mahran SA et al. (2021) Efficacy of Genicular Nerve Radiofrequency Ablation Versus Intra-Articular Platelet Rich Plasma in Chronic Knee Osteoarthritis: A Single-Blind Randomized Clinical Trial. Pain physician 24(2):127-34

RCT

n=200 (110 pulsed RF; 100 platelet rich plasma injection)

FU=12 months

Pulsed radiofrequency of the genicular nerves can be considered superior to knee intra-articular platelet-rich plasma injection for sustained pain relief and the lower severity index in patients with chronic knee osteoarthritis.

Captured in the Wu, 2022 network meta-analysis.

Gulec E, Ozbek H, Pektas S, Isik G. (2017) Bipolar Versus Unipolar Intra-articular Pulsed Radiofrequency Thermocoagulation in Chronic Knee Pain Treatment: A Prospective Randomized Trial. Pain physician 20(3):197-206.

RCT

n=100 (50 monopolar; 50 bipolar)

FU=3 months

Bipolar IAPRF is more advantageous in reducing chronic knee pain and functional recovery compared with unipolar IAPRF. Further studies with longer follow-up times, laboratory-based tests, and different generator settings are required to establish the clinical importance and well-defined mechanism of action of PRF.

Captured in the Wu, 2022 network meta-analysis.

Gupta A, Huettner DP, Dukewich M. (2017) Comparative Effectiveness Review of Cooled Versus Pulsed Radiofrequency Ablation for the Treatment of Knee Osteoarthritis: A Systematic Review. Pain physician 20(3):155-171.

Systematic review

n=17 studies

Overall, the studies showed promising results for the treatment of severe chronic knee pain by radiofrequency ablation at up to one year with minimal complications. Numerous studies, however, yielded concerns about procedural protocols, study quality, and patient follow-up. Radiofrequency ablation can offer substantial clinical and functional benefit to patients with chronic knee pain due to osteoarthritis or post total knee arthroplasty.

More recent systematic reviews included.

Han Q, Ma Y, Jia P, et al. (2021) A Randomized Controlled Pilot Study Comparing the Efficacy of Pulsed Radiofrequency Combined With Exercise Versus Exercise Alone in Pain Relief and Functional Improvement for Chronic Knee Osteoarthritis. Pain practice: the official journal of World Institute of Pain 21(2):160-170.

RCT

n=62 (32 pulsed RF; 32 exercise)

The improvement in pain relief and knee function might be associated with restoration of muscle strength after PRF-PS exercise by overcoming muscle inhibition.

RCTs with more patients or longer follow up included.

Hong T, Wang H, Li G, et al. (2019) Systematic Review and Meta-Analysis of 12 Randomized Controlled Trials Evaluating the Efficacy of Invasive Radiofrequency Treatment for Knee Pain and Function. BioMed research international 9037510.

Systematic review and meta-analysis

n=12 studies

RF treatment significantly reduces the knee pain, but rarely improves the knee joint function. Radiofrequency ablation has better efficacy than pulsed radiofrequency ablation in reducing pain. Furthermore, subgroup analysis and meta-regression suggested that women are more sensitive to RF treatment than men.

More recent systematic reviews included.

Hong T, Wang S, Ding Y, et al. (2020) High-Voltage Intra-articular Pulsed Radiofrequency for Chronic Knee Pain Treatment: A Single-Center Retrospective Study. Pain physician 23(5):e549-e558.

Cohort study

n=57

FU=6 months

CT-guided high-voltage intra-articular PRF is more beneficial in reducing knee pain and improving knee function compared with low-voltage intra-articular PRF. In addition, patients who received high-voltage intra-articular PRF were more satisfied with their treatment.

Experimental studies with more patients, or studies with longer follow up included.

Hong T, Li G, Han Z et al. (2020) Comparing the safety and effectiveness of radiofrequency thermocoagulation on genicular nerve, intra-articular pulsed radiofrequency with steroid injection in the pain management of knee osteoarthritis. Pain Physician 23(4specialissue):295-s303

Cohort study

n=97 (32 RF; 34 pulsed RF; 31 control)

FU=6 months

Both RF of the genicular nerve and intra-articular pulsed RF could alleviate the knee joint pain and improve the knee joint dysfunction; however, the treatment efficacy of RF of the genicular nerve was better than that of intra-articular pulsed RF.

Studies with more patients or longer follow up included.

Huang Y, Deng Q, Liuqing Y, et al. (2020) Efficacy and Safety of Ultrasound-Guided Radiofrequency Treatment for Chronic Pain in Patients with Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Pain Res Manag. 19(19).

Systematic review and meta-analysis

n=8 studies

Ultrasonography is an effective, safe, nonradiative, and easily applicable guidance method for RF in pain relief and functional improvement in KOA patients.

More recent meta-analyses included.

Hunter C, Davis T, Loudermilk E, et al. (2020) Cooled Radiofrequency Ablation Treatment of the Genicular Nerves in the Treatment of Osteoarthritic Knee Pain: 18- and 24-Month Results. Pain practice: the official journal of World Institute of Pain 20(3):238-246

Cohort study

n=33

FU=24 months

In this subset of subjects from a randomised controlled trial, CRFA provided sustained pain relief, improved function, and perceived positive effect through 24 months for subjects with osteoarthritis knee pain with no safety concerns identified.

Similar outcomes as Lyman (2022).

Ikeuchi M, Ushida T, Izumi M, Tani T. (2011) Percutaneous Radiofrequency Treatment for Refractory Anteromedial Pain of Osteoarthritic Knees. Pain Medicine 12(4):546-551.

Non-randomised, open-label study

n=35 (18 RFA; 17 nerve block)

FU=6 months

Some patients were able to benefit substantially from radiofrequency treatment. Even if its effective period is limited, radiofrequency application is a promising treatment to alleviate refractory anteromedial knee pain with osteoarthritis. Further experience and technical improvements are needed to establish its role in the management of knee osteoarthritis.

Studies with more patients or longer follow up included.

Jadon A, Jain P, Motaka M, et al. (2018) Comparative evaluation of monopolar and bipolar radiofrequency ablation of genicular nerves in chronic knee pain due to osteoarthritis. Indian Journal of Anaesthesia 62(11):876-880.

RCT

n=30 (15 monopolar; 15 bipolar)

FU=6 months

Bipolar RFA is an effective alternative for ablation of genicular nerves in patients with knee pain due to OA. It causes less procedural pain compared with monopolar RFA.

Captured in the Wu, 2022 systematic review and network meta-analysis.

Kapural L, Lee N, Neal K, Burchell M. (2019) Long-Term Retrospective Assessment of Clinical Efficacy of Radiofrequency Ablation of the Knee Using a Cooled Radiofrequency System. Pain physician 22(5):489-494.

Case series

n=205

This study demonstrates the clinical effectiveness of cooled RFA in the treatment of chronic knee pain from osteoarthritis, and even in those patients who maintained chronic knee pain after TKA. Our real-life data seems to agree with data previously published in a randomised controlled trial, despite the fact that this was quite a heterogenous patient population with various sources of chronic pain.,

Studies with more patients or longer follow up included.

Kocayigit H, Beyaz SG. (2021) Comparison of cooled and conventional radiofrequency applications for the treatment of osteoarthritic knee pain. Journal of Anaesthesiology Clinical Pharmacology 37(3):464-468.

Cohort study

n=63 (34 conRF; 29 cooled RF)

FU=6 months

We found that both cooled and conventional RF techniques in genicular nerve ablation are similarly effective in reducing pain in patients with osteoarthritis-induced knee pain and improving patients' physical functions. The complication rates are very low and there was no superiority to each other.

Studies with more patients or longer follow up included.

Leoni MLG, Schatman ME, Demartini L et al. (2020) Genicular nerve pulsed dose radiofrequency (PDRF) compared to intra-articular and genicular nerve PDRF in knee osteoarthritis pain: A propensity score-matched analysis. Journal of Pain Research 13:1315-1321.

Cohort study

n=78

FU=6 months

This is the first study that compared two different RF techniques. Pulsed RF of the genicular nerve and pulsed RF intra-articular + genicular nerve were both effective in reducing pain at 3- and 6-months follow-up. However, only PDRF intra-articular + genicular nerve was able to improve WOMAC scores at 3 months after the treatment with a longer period of efficacy compared to pulsed RF genicular nerve alone.

Studies with more patients or longer follow up included.

Li G, Zhang Y, Tian L, Pan J. (2021) Radiofrequency ablation reduces pain for knee osteoarthritis: A meta-analysis of randomized controlled trials. International journal of surgery 91:105951

Systematic review and meta-analysis

n=8 studies

RF ablation showed better effectiveness in relieving pain and promoting function recovery in patients with knee osteoarthritis. Considering the small sample size of the included studies, the results should be treated with caution.

More recent meta-analyses included.

McCormick ZL, Reddy R, Korn M, et al. (2018) A Prospective Randomized Trial of Prognostic Genicular Nerve Blocks to Determine the Predictive Value for the Outcome of Cooled Radiofrequency Ablation for Chronic Knee Pain Due to Osteoarthritis. Pain medicine (Malden, Mass) 19(8):1628-1638.

RCT

n=54 (29 cooled RF with block; 25 cooled RF without block)

FU=6 months

Clinically meaningful improvements in pain and function were observed at 6 months in over 60% of participants who underwent genicular nerve cooled RFA. However, genicular nerve block using the common protocol of 1mL local anaesthetic volume at each injection site and a threshold of >50% pain relief for subsequent cooled RFA eligibility did not improve the rate of treatment success.

Study focus is prognostic value of nerve block.

Mohamed OS, Omar SM, Gaber AF et al. (2021) Three Needles Approach-A New Technique of Genicular Nerves Radiofrequency Ablation for Pain Relief in Advanced Chronic Knee Osteoarthritis: A Randomized Trial. Pain physician 24(7):e1067-e1074.

RCT

n=50 (25 single needle; 25 three needle)

FU=6 months

Compared to the conventional single-needle genicular nerve ablation technique, the 3-needle approach appears to be a promising, safe, and more effective ablation technique for patients with chronic knee OA.

Studies with more patients or longer follow up included.

Monerris Tabasco MM, Roca Amatria G, Rios Marquez N, et al. (2019) Assessment of the effectiveness and safety of two radiofrequency techniques for the treatment of knee pain secondary to gonarthrosis. Prospective randomized double blind study. Revista espanola de anestesiologia y reanimacion. 66(7):362-369.

RCT

n=28 (12 pulsed and conventional RF; 16 placebo)

FU=6 months

The combination of two radiofrequency techniques, does not cause a reduction in the intensity of the knee pain, at month, three, or at six months after its completion. It is necessary to change the radiofrequency technique and include more variables to continue with the efficacy study.

Captured in the Wu, 2022 systematic review and network meta-analysis.

Orhurhu V, Urits I, Grandhi R, Abd-Elsayed A. (2019) Systematic Review of Radiofrequency Ablation for Management of Knee Pain. Current pain and headache reports 23(8):55.

Systematic review

n=19 studies

In summary, the data available suggests radiofrequency ablation as a promising and efficacious with all 19 studies revealing significant short- and long-term pain reductions in patients with knee pain.

More recent systematic reviews included.

Philip A, Williams M, Davis J, et al. (2021) Evaluating predictors of pain reduction after genicular nerve radiofrequency ablation for chronic knee pain. Pain management 11(6):669-677.

Case series

n=124

Identifying patients who may benefit the most from genicular RFA is still not clear. Pain reduction differences between patients with and without depression and RFA type deserves further exploration.

Studies with more patients or longer follow up included.

Ray D, Goswami S, Dasgupta S, Ray S, Basu S. (2018) Intra-Articular hyaluronic acid injection versus RF ablation of genicular nerve for knee osteoarthritis pain: A randomized, open-label, clinical study. Indian Journal of Pain 32(1):36-39.

RCT

n=24 (12 RF; 12 control)

As compared to intra-articular hyaluronic acid injection, RF neurotomy of genicular nerves appears to be a promising and more effective therapeutic procedure for patients with chronic knee OA.

Captured in the Wu, 2022 systematic review and network meta-analysis.

Sajan A, Mehta T, Griepp DW, et al. (2022) Comparison of Minimally Invasive Procedures to Treat Knee Pain Secondary to Osteoarthritis: A Systematic Review and Meta-Analysis. Journal of vascular and interventional radiology : JVIR. 33(3):238-248e4.

Systematic review and meta-analysis

n=11 studies

The current evidence does not suggest a significant difference in outcomes among IA injection, RF ablation, and genicular artery embolisation for knee pain secondary to OA.

More comprehensive network meta-analysis included.

Santana-Pineda MM, Vanlinthout LE, Santana-Ramirez S et al. (2021) A Randomized Controlled Trial to Compare Analgesia and Functional Improvement After Continuous Neuroablative and Pulsed Neuromodulative Radiofrequency Treatment of the Genicular Nerves in Patients with Knee Osteoarthritis up to One Year After the Intervention. Pain medicine (Malden, Mass.) 22(3):637-52

RCT

n=216 (108 pulsed RF; 108 conventional RF)

FU=12 months

Therapeutic efficacy and reduction in analgesic consumption were superior after conventional RF. Treatment success at 6 months after radiofrequency intervention decreased with more severe gonarthritis; higher pre-interventional pain intensity; and concomitant depression, anxiety disorder, and diabetes mellitus.

Captured in the Wu, 2022 network meta-analysis.

Sari S, Aydin ON, Turan Y et al. (2018) Which one is more effective for the clinical treatment of chronic pain in knee osteoarthritis: radiofrequency neurotomy of the genicular nerves or intra-articular injection?. International journal of rheumatic diseases 21(10):1772-1778.

RCT

n=73 (37 RF; 36 intra-articular injection)

FU=3 months

This study is the first controlled study in the literature which compares RF genicular nerve to intra-articular injections. This study demonstrated that genicular nerve RF neurotomy is a safe and efficient treatment modality and provides functional improvement along with an analgesia in patients with chronic knee OA.

Captured in the Wu, 2022 systematic review and network meta-analysis.

Shen WS, Xu XQ, Zhai NN, et al. (2017) Radiofrequency Thermocoagulation in Relieving Refractory Pain of Knee Osteoarthritis. American journal of therapeutics 24(6):e693-e700.

RCT

n=54 (27 RF; 27 control)

FU=3 months

RFA may have better efficacy in relieving refractory pain and promoting function recovery in patients with knee OA than regular treatment.

Studies with more patients or longer follow up included.

Takahashi K, Hashimoto S, Kurosaki H et al. (2016) A pilot study comparing the efficacy of radiofrequency and microwave diathermy in combination with intra-articular injection of hyaluronic acid in knee osteoarthritis. Journal of physical therapy science 28(2)

RCT

n=17 (9 RF; 9 control)

FU=3 weeks

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.

Studies with more patients or longer follow up included.

Uematsu H, Osako S, Hakata S, et al. A Double-Blind, Placebo-Controlled Study of Ultrasound-Guided Pulsed Radiofrequency Treatment of the Saphenous Nerve for Refractory Osteoarthritis-Associated Knee Pain. Pain physician 24(6):e761-e769.

RCT

n=70 (37 pulsed RF;33 sham)

FU=12 weeks

Ultrasound-guided saphenous nerve PRF proved to be effective for at least 12 weeks in patients with knee OA and showed no adverse events.

Studies with more patients or longer follow up included.

Wang R, Ma C, Han Y, Tan M, Lu L. (2019) Effectiveness of Denervation Therapy on Pain and Joint Function for Patients with Refractory Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Pain physician 22(4):341-352.

Systematic review and meta-analysis

n=6 studies

Denervation of the knee joint may become a promising therapy for patients with knee OA who are refractory to conservative treatment. This therapy can provide short-term therapeutic effect in pain alleviation for 6 months and joint function recovery for 3 months. The therapeutic effect in joint function may decrease 6 months after operation. The long-term efficacy in pain remission and function improvement is still elusive and controversial; therefore, further research with larger sample sizes are needed in the future.

More recent meta-analyses included.

Wong PKW, Kokabi N, Guo Y, et al. (2021) Safety and efficacy comparison of three- vs four-needle technique in the management of moderate to severe osteoarthritis of the knee using cooled radiofrequency ablation. Skeletal radiology 50(4):739-750.

Cohort study

n=50

FU=6 months

The four-needle treatment approach offers an advantage in the overall efficacy in treating stiffness and pain in patients with moderate-to-severe OA refractory to conservative treatments leading to decreased opiate usage without complications.

Studies with more patients or longer follow up included.

Wu BP, Grits D, Foorsov V et al. (2022) Cooled and traditional thermal radiofrequency ablation of genicular nerves in patients with chronic knee pain: a comparative outcomes analysis. Reg Anesth Pain Med 0: 1-6

Cohort study (retrospective)

n=208

FU=1 year

Both thermal RF ablation and cooled RF ablation effectively reduced NRS pain scores in most patients with chronic knee pain within the 1-year follow-up period. Genicular nerve thermal RF ablation was associated with a higher probability of treatment success and a greater degree of pain relief at 1 month after the procedure when compared with cooled RF ablation in propensity score matched patients with chronic knee pain.

Studies with better designs or more patients included.

Xiao L, Shu F, Xu C, et al. (2018) Highly selective peripheral nerve radio frequency ablation for the treatment of severe knee osteoarthritis. Experimental and Therapeutic Medicine 16(5):3973-3977.

RCT

n=96 (49 RF; 47 control)

FU=12 months

Compared with sodium hyaluronate injection, highly selective peripheral nerve RF ablation of the knee was more effective, easy to operate and had no significant adverse effects for the treatment of knee OA.

Captured in the Wu, 2022 systematic review and network meta-analysis.

Yuan Y, Shen W, Han Q, et al. (2016) Clinical observation of pulsed radiofrequency in treatment of knee osteoarthritis. International Journal of Clinical and Experimental Medicine 9(10):20050-20055.

RCT

n=42 (22 pulsed RF; 20 control)

FU=24 weeks

The effect of intra-articular pulsed RF treatment is obviously superior to the traditional compound betamethasone injection group in the treatment for refractory knee osteoarthritis; pulsed RF could obviously alleviate the clinical symptoms and decrease the content of TNF-alpha, MMP-3 and IL-1 in the synovial, in addition, it is safe and reliable, all of these make it an effective method for senile refractory knee osteoarthritis

Captured in the Wu, 2022 systematic review and network meta-analysis.

Zeitlinger L, Kopinski J, Dipasquale T (2019). Genicular nerve ablation: A systematic review of procedure outcomes for chronic knee pain. Current Orthopaedic Practice 30(5):477-483.

Systematic review

n=11 studies

Genicular nerve ablation with radiofrequency has demonstrated favourable outcomes with low complication rates.

More recent systematic reviews included.

Zhang H, Wang B, He J, and Du Z. (2021) Efficacy and safety of radiofrequency ablation for treatment of knee osteoarthritis: a meta-analysis of randomized controlled trials. The Journal of international medical research 49(4): 3000605211006647

Systematic review and meta-analysis

n=9 studies

Radiofrequency ablation is efficacious and safe for reducing pain and improving knee function in patients with knee osteoarthritis, without increasing the risk of adverse effects.

Same studies and outcomes as Li (2021).