Philip Kin-Wai Wong1,2, Nima Kokabi1,2, Yi Guo3, David Reiter1,2, Nickolas Bernard Reimer4, Shervin Oskouei4, Felix M Gonzalez5,6,7. 1. Emory University School of Medicine, Atlanta, GA, USA. 2. Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA. 3. Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA. 4. Department of Orthopedics, Emory University School of Medicine, Atlanta, GA, USA. 5. Emory University School of Medicine, Atlanta, GA, USA. felix.m.gonzalez@emory.edu. 6. Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA. felix.m.gonzalez@emory.edu. 7. Department of Radiology and Imaging Sciences, Section of Musculoskeletal Imaging, Emory Orthopaedics and Spine Center, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA, 30329, USA. felix.m.gonzalez@emory.edu.
Abstract
PURPOSE: To analyze the safety and efficacy of image-guided genicular nerve cooled radiofrequency ablation (C-RFA) for the treatment of pain in non-surgical candidates with moderate to severe knee osteoarthritis (OA) and to compare three- vs four-needle technique. METHOD: This retrospective study included 50 consecutive patients with pain from moderate to severe knee OA refractory to anti-inflammatory analgesia that failed multiple intra-articular lidocaine-steroid injections and who were non-surgical total knee arthroplasty candidates because of comorbidities. Patients initially underwent anesthetic blocks of the superior medial/lateral femoral and inferior medial tibial genicular nerve branches and in some cases the suprapatellar genicular nerve branch. Radiofrequency ablations of the same nerve branches were performed 1-2 weeks after the nerve blocks. Follow-up outcome was collected at approximately 2 weeks, 1, 3, and 6 months after the C-RFA procedure utilizing VAS and clinically validated questionnaires. RESULTS: A total of 77 knees were treated. The mean total KOOS score improved significantly from baseline at 24.7 ± 14.1 to 59.4 ± 26.5 at 6 months after treatment (p < 0.0001), with significant improvement in mean pain score from 25.5 ± 15.2 to 64.5 ± 25.2 (p < 0.0001) and mean stiffness score from 35.1 ± 21.9 to 65.8 ± 24.9 (p < 0.0001). At 6 months, 65% of all patients demonstrated decreased opiate medication usage, 79% of patients in the four-needle, and 45% of patients in the three-needle arms (p = 0.03). No complications were reported. CONCLUSIONS: 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.
PURPOSE: To analyze the safety and efficacy of image-guided genicular nerve cooled radiofrequency ablation (C-RFA) for the treatment of pain in non-surgical candidates with moderate to severe knee osteoarthritis (OA) and to compare three- vs four-needle technique. METHOD: This retrospective study included 50 consecutive patients with pain from moderate to severe knee OA refractory to anti-inflammatory analgesia that failed multiple intra-articular lidocaine-steroid injections and who were non-surgical total knee arthroplasty candidates because of comorbidities. Patients initially underwent anesthetic blocks of the superior medial/lateral femoral and inferior medial tibial genicular nerve branches and in some cases the suprapatellar genicular nerve branch. Radiofrequency ablations of the same nerve branches were performed 1-2 weeks after the nerve blocks. Follow-up outcome was collected at approximately 2 weeks, 1, 3, and 6 months after the C-RFA procedure utilizing VAS and clinically validated questionnaires. RESULTS: A total of 77 knees were treated. The mean total KOOS score improved significantly from baseline at 24.7 ± 14.1 to 59.4 ± 26.5 at 6 months after treatment (p < 0.0001), with significant improvement in mean pain score from 25.5 ± 15.2 to 64.5 ± 25.2 (p < 0.0001) and mean stiffness score from 35.1 ± 21.9 to 65.8 ± 24.9 (p < 0.0001). At 6 months, 65% of all patients demonstrated decreased opiate medication usage, 79% of patients in the four-needle, and 45% of patients in the three-needle arms (p = 0.03). No complications were reported. CONCLUSIONS: 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.
Authors: Kamil E Barbour; Judy A Stevens; Charles G Helmick; Yao-Hua Luo; Louise B Murphy; Jennifer M Hootman; Kristina Theis; Lynda A Anderson; Nancy A Baker; David E Sugerman Journal: MMWR Morb Mortal Wkly Rep Date: 2014-05-02 Impact factor: 17.586
Authors: Adham Aboul Fotouh; Mona Hamdy; Fatma Ali; Eman F Mohamed; Abdallah Allam; Waleed A Hassan; Ahmed Elsaman; Amany El-Najjar; Marwa A Amer; Doaa Mosad; Samar Tharwat; Samah A El Bakry; Hanan Saleh; Ahmed Zaghloul; Mostafa Mahmoud; Reem H A Mohammed; Hanan El-Saadany; Hanan M Fathi; Nevin Hammam; Hala A Raafat; Ashraf N Moharram; Tamer A Gheita Journal: Open Access Rheumatol Date: 2022-04-11