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Objective:
The primary objective of this observational, prospective, multicenter study was to evaluate the long-term outcomes, including pain, function, and perceived effect of treatment, in cooled radiofrequency ablation (CRFA) subjects who have pain due to osteoarthritis (OA) of the knee.
Methods:
This analysis included a subset of subjects pr...
Context in source publication
Context 1
... mean (AESD) baseline NRS pain score for subjects treated with CRFA was significantly decreased (P < 0.0001), from 6.6 AE 1.6 at baseline to 3.1 AE 2.7 (n = 25) and 3.6 AE 2.8 (n = 18) at 18 and 24 months, respectively. Results in Table 2 and Figure 3 contain data specifically from the subjects included in the * Data are presented as mean and standard deviation (SD) along with 95% confidence interval (CI). † Data from the original study were included from baseline to 12 months for subjects enrolled in this extension study. ...
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To evaluate safety and efficacy of one- vs. two-session radiofrequency ablation (RFA) of parathyroid hyperplasia for patients with secondary hyperparathyroidism (SHPT) and to compare the outcome of both methods on hypocalcemia. Patients with secondary hyperparathyroidism underwent ultrasound guided RFA of parathyroid hyperplasia. Patients were alte...
Citations
... Particularly in the lower extremity RFA has been used to treat chronic pain by ablating the articular branches supplying the joints. These include the articular sensory branches of the femoral and obturator nerves in the hip (10) and the genicular nerves in the knee (11) . RFA of the lateral femoral cutaneous nerve has also been used to great effect in the setting of meralgia paresthetica (12) . ...
Lower extremity peripheral neuropathy is a commonly encountered neurologic disorder, which can lead to chronic pain, functional disability, and decreased quality of life for a patient. As diagnostic imaging modalities have improved, imaging has started to play an integral role in the detection and characterization of peripheral nerve abnormalities by non-invasively and accurately identifying abnormal nerves as well as potential causes of neuropathy, which ultimately leads to precise and timely treatment. Ultrasound, which has high spatial resolution and can quickly and comfortably characterize peripheral nerves in real time along with associated denervation muscle atrophy, and magnetic resonance neurography, which provides excellent contrast resolution between nerves and other tissues and between pathologic and normal seg- ments of peripheral nerves, in addition to assessing reversible and irreversible muscle denervation changes, are the two mainstay imaging modalities used in peripheral nerve assessment. These two modalities are complimentary, and one may be more useful than the other depending on the nerve and location of pathol- ogy. Imaging must be interpreted in the context of available clinical information and other diagnostic stud- ies, such as electrodiagnostic tests. Here, we offer a comprehensive overview of the role of high-resolution ultrasound and magnetic resonance neurography in the evaluation of the peripheral nerves of the lower extremity and their associated neuropathies.
... Its early diagnosis and the offer of increasingly less invasive and more effective treatments are a growing need as it predominantly affects adults of working age who are economically active, representing a threat to their financial stability and family well-being, as could be seen in the present study. Radiofrequency has been shown to be an effective non-invasive technique for chronic pain almost immediately after the procedure, with effectiveness and absence of significant complications over time [13][14][15]. Therefore, it has gained greater confidence for its use, and the availability of this type of technology around the world has improved, especially in Latin America where its growth has been slow but with good results. ...
Background: Lower back and radicular pain are leading causes of disability and loss of quality of life, especially due to its high prevalence in the general population. Cooled radiofrequency treatment (CRT) has emerged as a novel non-invasive technique for the management of discogenic pain with safe and effective results. The aim of this study was to evaluate the effectiveness of CRT in the treatment of radicular pain secondary to a lumbar hernia in patients with chronic neuropathic pain after receiving conservative treatment that did not achieve adequate pain management.
Methods: A prospective study of patients undergoing CRT for the management of discogenic low back pain was carried out. When attending the first evaluation and corroborating the lumbar hernias by magnetic resonance imaging (MRI), treatment was offered one month of physiotherapy before CRT. To assess the evolution of the patients, measurements were taken before and after the intervention with the visual analog scale (VAS) and the Oswestry low back pain disability scale (OLBPDS) scores.
Results: A total of 74 patients (mean age: 48.42 ± 14.32 years, 66.11% female) were included, who were undergoing a total of 134 herniated intervertebral lumbar discs. When comparing the initial perception of low back pain and after finding a non-significant partial improvement with one month of physiotherapy treatment, it was observed that the patients who were offered CRT showed an average improvement in discogenic pain of 79.92% (p = <0.0001, 95% CI: -7.010 to -6.379) in 98.64% of cases. This was accompanied by an increase in their functionality of daily living activities, as measured by OLBPDS. No patients presented significant adverse events, and in the only case where the desired pain management was not obtained, the patient's discomfort did not worsen.
Conclusions: Intradiscal biacuplasty by CRT is a considerable treatment for lumbar radiculopathy. Postoperative results demonstrated its effectiveness and safety in the management of radicular pain without the presence of significant adverse effects.
... 9 10 While there have not been any large, prospective, randomized trials comparing the two in clinical practice, literature on genicular nerve ablations has confirmed extended clinical durability for SRF up to 12 months [11][12][13] and CRF up to 24 months. [14][15][16] These studies suggest that lesion size and the amount of energy delivered to a target nerve may impact clinical durability. Therefore, it is important for clinicians to understand the factors that influence RFA lesion size and shape, so they can select the appropriate generator and probe configurations for ideal interventional success and desired tissue damage. ...
Introduction
Preclinical research demonstrated water-cooled radiofrequency (CRF) ablations have a significant impact on structural and functional changes compared to standard radiofrequency (SRF) ablations. Clinical procedures utilizing RF to treat chronic pain conditions also show sustained functional outcomes. We hypothesize that the design of the RF probes plays an important role in interventional procedure success, but it remains unclear which specific design features.
Methods
RF ablations were performed in male Lewis rats (n=51) using multiple-sized probes for CRF (17 Ga/2 mm and 17Ga/4 mm) and SRF (22Ga/5 mm, 18Ga/10 mm and 16Ga/10 mm) to evaluate generator energy output, lesion length, axon damage by histology and nerve function analysis via electromyography. To exclude probe design variables beyond size and remain objective, we tested cooled probes with and without water circulation, which resulted in the CRF probe performing like an SRF probe.
Results
Consistent with our previous findings in smaller probes, CRF large probes delivered more energy (p<0.01) and generated multiple zones of thermal damage in sciatic nerves. When the water-circulating feature was turned off, however, energy output (p<0.001) and lesion length (p<0.05) was significantly reduced. CRF probes with the water circulation also featured significantly more axonal disruption, than larger sized SRF probes (p<0.0001).
Conclusions
Overall, this data confirms that CRF’s water-circulating technology has a greater impact on energy deposition, lesion length and axon damage compared with SRF ablations. Moreover, results suggest that the structural differences between RF modalities cannot be solely attributed to probe size, and it may shed light on its differences in clinical outcomes.
... Compared to IACIs, 74.1% of cooled RFA subjects reported greater than 50% pain relief versus 16.2% in the injection group at 6 months [72]. Against HA injection, in a multicenter randomized trial, Chen et al. reported that 71% of cooled RF participants had a 50% reduction in NRS pain score while 38% of the HA group achieved the same results [73]. ...
Purpose of Review
Osteoarthritis (OA) of the knee is a common disease with associated direct and indirect costs having a significant societal impact. This review is conducted to discuss various treatment options for knee OA, highlight the most recent evidence regarding efficacy, and devise clinical recommendations to meet the needs of the patients.
Recent Findings
Pharmacologically, options tend to be limited. Simple analgesics such as acetaminophen and nonsteroidal anti-inflammatory drugs are widely used, with efficacy and safety being questioned. Mild opioids can be considered, although strong opioids are discouraged and need to be incorporated with great caution. Therapeutic exercises and weight loss have been the cornerstone of knee OA management. Symptomatic relief can be achieved with intra-articular steroids, hyaluronic acid, and orthobiologics injections as well. More recently, genicular nerve neurotomy has been introduced to the treatment algorithm and shown promising results, although some refinement of the technique is likely needed in the future.
Summary
A proper and astute approach is adopting a comprehensive treatment program encompassing multimodal and multidisciplinary modalities. Future direction should focus on the clinical success of such effort in terms of pain and function improvement, patient satisfaction, and reduction in a financial burden to the health care system.
... Moreover, some studies have demonstrated that pain relief after genicular RFA can even last for 24 months. 28 Recently, Fonkoue and colleagues proposed that targeting two additional genicular nerves (the recurrent fibular nerve and infrapatellar branch of the saphenous nerve) could improve the pain relief outcome. 37,38 However, this is still questionable and long-term study is still lacking on this topic. ...
... EQ-5D-5L, EuroQol Group questionnaire with 5 dimensions and 5 levels of severity; Thai KOOS-PS, Thai knee injury and osteoarthritis outcome score physical function short form; BPI-T, brief pain inventory. 15,28,36 Although we found a non-homogenous result from each questionnaire at each time point, the trend for the score seemed to be ameliorated. In our study, we found no different improvement in the risk of a fall from the fall evaluation questionnaire, which might have been because of the already low risk of a fall in the baseline characteristics of the patients (median score of 10 out of 12). ...
Objective: When patients with chronic osteoarthritis (OA) knee pain do not respond to conservative treatment and are not suitable for knee arthroplasty, radiofrequency ablation (RFA) of the genicular nerve is probably an alternative treatment. This study aimed to evaluate the efficacy and safety of genicular nerve ablation in severe osteoarthritic knee pain patients. Materials and Methods: Patients with severe chronic OA knee pain were recruited and performed a genicular nerve block (GNB). The patients’ demographic data, numerical rating scale (NRS) at rest and on movement, Thai Oxford knee score (Thai OKS), Thai knee injury and osteoarthritis outcome score physical function short form (Thai KOOS-PS), timed up and go test, brief pain inventory, fall evaluation, and EuroQol 5D-5L were recorded. For the positive block patients (≥50% pain relief for 24 hours), genicular nerve RFA was performed under fluoroscopic or ultrasound guidance. All patients were followed up at the 1st, 3rd, 6th, 9th and 12th months. Results: 21 patients were included in the study, but only 17 were completely followed up for 12 months. At the 12th month, genicular nerve RFA reduced the mean NRS on movement from 7.9±1.6 to 4.0±2.6 (p=0.005), improved knee function (Thai OKS from 18.8±5.3 to 28.5±10.1; p=0.006), but did not significantly improve quality of life (EuroQol-5D-5L from 0.43±0.20 to 0.69±0.33; p=0.130). No adverse events were observed. Conclusion: Genicular nerve radiofrequency ablation in severe chronic OA knee patients demonstrated significant pain relief and functional improvement for up to 12 months without serious adverse events.
... They demonstrated that at 12 months, 65% of the original CRFA group had pain reduction ≥ 50%, and the mean overall drop was 4.3 points (p < 0.0001) on the numeric rating scale, while 75% reported 'improved' effects. Hunter et al. [45] performed an extended evaluation of the patients enrolled in the study of Davis et al. [18] at 18-and 24-months post-intervention, showing a perceived positive effect with a mean NPRS score of 3.1 ± 2.7, and 3.6 ± 2.8, respectively. In another multicenter, randomized clinical trial, Chen et al. [17] compared the effectiveness of CRFA and a single injection of hyaluronic acid for the treatment of chronic knee pain; at 12-months, 65.2% of participants in the CRFA cohort reported ≥ 50% pain relief from baseline with a mean NPRS of 2.8 ± 2.4 (baseline 6.9 ± 0.8). ...
Background:
Cooled radiofrequency ablation (CRFA) and cryoneurolysis (CRYO) are two novel methods of genicular neurolysis to relief pain in symptomatic knee osteoarthritis (KOA). In this study, the two methods will be compared, giving us the opportunity to investigate their efficacy, safety and complications.
Methods:
In this prospective randomized trial 70 patients with KOA will be recruited using a diagnostic block of four genicular nerves. Two groups will be created through software randomization: a CRFA group (35 patients) and a CRYO group (35 patients). The target of the interventions will be four genicular nerves; the superior medial, superior lateral, inferior medial, as well as the medial (retinacular) genicular branch from vastus intermedius. The primary outcome of this clinical trial will be the efficacy of CRFA or CRYO at 2-, 4-, 12-and 24-weeks post-intervention using the Numerical Rating Pain Scale (NRPS). The secondary outcomes are the safety of the two techniques, as well as the clinical evaluation using the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Oxford Knee Score (OKS), and the 7-point scale of Patient Global Impression of Change (PGIC).
Discussion:
These two novel techniques can block pain transmission through genicular nerves in different ways. In contrast to cryoneurolysis, the CRFA method has been well documented in the past. This is the first clinical trial to compare CRFA vs CRYO and draw conclusions about their safety and efficacy.
Trial registration:
ISRCTN87455770 [ https://doi.org/10.1186/ISRCTN87455770 ]. Registered 29/3/2022, first patient recruited 31/8/2022.
... They concluded that CRFA provides sustained pain relief and improved knee function even for 24-month duration. [25] Overall most of the studies mentioned in the above discussion, demonstrated that cooled RFA provides effective pain relief for 12-month duration. ...
... They concluded that CRFA provides sustained pain relief and improved knee function even for 24-month duration. [25] Overall most of the studies mentioned in the above discussion, demonstrated that cooled RFA provides effective pain relief for 12-month duration. ...
... Una vez ya descritos los estudios referente al bloqueo nervioso guiado por ultrasonido, se revisará de manera similar a la ablación nerviosa como método terapéutico para reducir el dolor asociado a osteoartritis de rodilla, el objetivo de esta técnica es denervar parcial o totalmente la cápsula anterior de la rodilla. 27 Hunter C et al. 28 evaluaron los resultados a largo plazo de la ablación por radiofrecuencia enfriada (CRFA) dando seguimiento a 33 pacientes que fueron parte de un estudio previo en el que se trató a 42 pacientes con CRFA y 41 con inyección intraarticular de esteroides. 25 pacientes fueron evaluados mediante NRS, OKS y GPE a los 18 meses y 18 pacientes a los 24 meses con las mismas herramientas. ...
... 19,31,32 Al unísono, se evidenció que el tiempo de seguimiento era otro factor limitante, por lo que sólo dos estudios tuvieron el seguimiento de más de un año. 28,32 Sin embargo, a pesar de las limitantes expuestas, existieron puntos a favor que se deben destacar, como el que todos los estudios utilizaron como instrumento de eva-luación, escalas validadas y que garantizan la reproducibilidad del mismo. Además, los participantes fueron elegidos conforme a razonables criterios de inclusión, descritos en cada apartado metodológico. ...
... La ablación por radiofrecuencia enfriada (CRFA), es un tipo de ablación nerviosa que usa la degradación térmica por medio de sondas de radiofrecuencia refrigeradas dirigida a los nervios sensoriales con la intención de aliviar el dolor. 38 Hunter C et al. 28 mostró resultados prometedores de este tratamiento en parámetros de función y dolor a largo plazo, dato que hace aún más fidedigna esta investigación. La técnica con la que se hace este procedimiento se basa en la preferencia del operador y la anatomía del paciente según los resultados de Wong PK et al. 29 y Jadon A et al. 30 puesto que ninguna técnica mostró diferencias significativas sobre otra. ...
Introduction: Osteoarthritis (OA) is the most prevalent
rheumatic pathology worldwide, which causes intense
chronic pain, especially in supporting joints, such as the
knee. Among the new therapeutic targets for OA of the
knee, there is the nerve block along with its various types
and techniques, which help to significantly improve pain
and overall functionality of the patient.
Objective: To analyze the current evidence on the types
and techniques of nerve blocks in knee osteoarthritis.
Methods: A systematic review was performed following
PRISMA guidelines, of different studies according to the
inclusion criteria, in the database of: PubMed, MedScape,
ScienceDirect, Scopus and ProQuest, from January 2018
to January 2023.
Results: In the systematic search, 9034 articles were
obtained, after eliminating duplicates and according to
the inclusion and exclusion criteria, a total of 19 articles
were filtered, among them 10 were randomized controlled
trials and 9 were observational studies, which met all the
eligibility criteria.
Conclusion: According to the results of the studies, there
is evidence of the efficacy and safety of genicular blockade in the relief of chronic pain in knee OA, being a
recommendable option as a complement in the therapeutic approach of this pathology. The technique to be
applied depends on the clinical context of the patient
and the professional who will perform the procedure, the
long-term results have no significant difference.
... Ann Joint 2023;8:5 | https://dx.doi.org/10.21037/aoj-22-33 management of knee OA pain, as well as a cost-effective benefit with respect to accepted measures (13,21,22). The current study differed from most other RFA studies because this study did not require a minimum pretreatment pain score as part of the inclusion criteria. ...
