Genicular Nerve Radiofrequency Ablation Versus Hyaluronic Acid Injection for Knee Osteoarthritis Pain (RF-PROSPECTIU)
A Prospective Comparative Study of Conventional Conservative Treatment Versus Genicular Radiofrequency Ablation in Non-Surgical Knee Osteoarthritis: A Randomized Controlled Trial of Thermal Radiofrequency of the Genicular Nerves Versus Intra-Articular Hyaluronic Acid
The goal of this clinical trial is to learn if thermal radiofrequency ablation of the genicular nerves (the nerves that carry pain signals from the knee) works better than a single injection of hyaluronic acid into the knee to relieve pain in adults with knee osteoarthritis who have not improved with conservative treatment. The study also includes patients with severe knee osteoarthritis who are not candidates for knee replacement surgery.
The main questions it aims to answer are:
- Does genicular nerve radiofrequency reduce knee pain during movement more than hyaluronic acid over 12 months?
- Does it improve knee function and quality of life, and does its effect last longer?
Researchers will compare radiofrequency ablation with hyaluronic acid injection to see which treatment gives greater and longer-lasting pain relief.
Participants will:
- Be randomly assigned to one of the two treatments.
- If assigned to radiofrequency, first receive a diagnostic nerve block with local anesthetic. Only those whose pain decreases by at least 50% will then receive radiofrequency ablation, in a single ultrasound-guided session.
- If assigned to hyaluronic acid, receive a single injection of hyaluronic acid into the knee.
- Attend follow-up visits at 1, 3, 6 and 12 months, where they will rate their pain and answer questionnaires about knee function, overall status and quality of life.
Tutkimuksen yleiskatsaus
Tila
Tila
Ehdot
Ehdot
Interventio / Hoito
Interventio / Hoito
Yksityiskohtainen kuvaus
Knee osteoarthritis is a leading cause of chronic pain and disability. Conventional conservative treatments, such as non-steroidal anti-inflammatory drugs and intra-articular hyaluronic acid, provide partial and time-limited relief. Thermal radiofrequency ablation of the genicular nerves is a minimally invasive technique that interrupts pain transmission from the knee joint. Most published studies have short follow-up (3-6 months), and evidence is scarce in patients with advanced osteoarthritis (Kellgren-Lawrence grade IV) who are not candidates for total knee arthroplasty because of severe comorbidity, morbid obesity or a documented multidisciplinary decision.
Design: single-center, randomized, parallel-group (1:1) controlled trial conducted at Hospital Universitari Joan XXIII de Tarragona (Spain). Patients and clinicians are not blinded; the outcome assessor and the statistician are blinded to treatment allocation.
Randomization: computer-generated sequence (sealedenvelope.com) with variable block sizes, stratified by Kellgren-Lawrence grade (II-III vs IV) and body mass index (<40 vs >=40 kg/m2).
Interventions: in the radiofrequency group, an ultrasound-guided diagnostic block of the superomedial, superolateral and inferomedial genicular nerves (1 ml of 1% lidocaine per nerve) is performed first. Patients with at least 50% pain reduction within 4 hours undergo ultrasound-guided thermal radiofrequency ablation of the same nerves (80 C for 90 seconds per nerve). Patients with a negative block do not receive radiofrequency, are withdrawn from the study and are reported in the CONSORT flow diagram. In the hyaluronic acid group, patients receive a single 6 ml intra-articular injection of high molecular weight hyaluronic acid (hylan G-F 20 or similar).
Sample size: 25 patients per group are required to detect a minimal clinically important difference of 2 points in the visual analogue scale (standard deviation 2.5, power 80%, two-sided alpha 0.05). Allowing for 20% losses over 12 months, 35 patients per group (70 in total) will be included.
A pre-specified subgroup analysis will compare treatment response in Kellgren-Lawrence grade II-III versus grade IV patients, and according to comorbidity (Charlson Comorbidity Index) and body mass index. Health-related quality of life data will be collected for a potential cost-effectiveness analysis.
Opintotyyppi
Opintotyyppi
Ilmoittautuminen (Arvioitu)
Ilmoittautuminen
Vaihe
Vaihe
- Ei sovellettavissa
Yhteystiedot ja paikat
Opiskeluyhteys
Opiskeluyhteys
- Nimi: Laura Pallares Valls, MD
- Puhelinnumero: +34 646973140
- Sähköposti: laura-pallares@hotmail.com
Tutki yhteystietojen varmuuskopiointi
- Nimi: Marta Sabater Martos, PhD
- Puhelinnumero: 676625869
- Sähköposti: Sabaterms@gmail.com
Opiskelupaikat
-
-
Tarragona
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Tarragona, Tarragona, Espanja, 43005
- Hospital Universitari Joan XXIII de Tarragona
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Ottaa yhteyttä:
- Laura Pallarès Valls, MD
- Puhelinnumero: +34 646973140
- Sähköposti: lpallares.hj23.ics@gencat.cat
-
-
Osallistumiskriteerit
Kelpoisuusvaatimukset
Kelpoisuusvaatimukset
Opintokelpoiset iät
Hyväksyy terveitä vapaaehtoisia
Sukupuolet, jotka voivat opiskella
Kuvaus
Inclusion Criteria:
- Adults (18 years or older) with symptomatic knee osteoarthritis of more than 6 months' duration.
- Pain during movement >4 on a 0-10 visual analogue scale.
- Failure of conservative treatment: pain during movement >4 despite at least 3 months of NSAIDs and/or rehabilitation (physical therapy), documented in the medical record. Patients with a documented contraindication to NSAIDs may be included if they have undergone rehabilitation.
- Radiographic Kellgren-Lawrence grade II or III, or
- Kellgren-Lawrence grade IV in patients who are not candidates for total knee arthroplasty because of at least one of the following: body mass index >39.9 kg/m2; Charlson Comorbidity Index >=5 (original, not age-adjusted); or a documented multidisciplinary decision of the Orthopaedic Surgery Department.
- Signed informed consent.
Exclusion Criteria:
- Acute or chronic knee joint infection.
- Intra-articular hyaluronic acid or corticosteroid injection in the previous 6 months.
- Coagulopathy or anticoagulant treatment that does not allow a safe therapeutic window for the procedure.
- Major lower limb surgery in the previous 6 months that may affect function or pain of the index knee (including contralateral total or partial knee arthroplasty, hip arthroplasty, or tibial or femoral osteotomy).
- Cardiac pacemaker or metallic implant (contraindication for radiofrequency).
- Known allergy to hyaluronic acid.
- Severe dementia.
- Institutionalized patients.
- Decompensated systemic disease.
- Active neurological or inflammatory rheumatological disease.
- Terminal oncological disease.
- Inability to understand the study questionnaires.
- Radiofrequency arm only: negative diagnostic genicular nerve block (<50% pain reduction within 4 hours).
Opintosuunnitelma
Miten tutkimus on suunniteltu?
Suunnittelun yksityiskohdat
- Ensisijainen käyttötarkoitus: Hoito
- Jako: Satunnaistettu
- Inventiomalli: Rinnakkaistehtävä
- Naamiointi: Yksittäinen
Aseiden lukumäärä
Aseet ja interventiot
Osallistujaryhmä / ArmOsallistujaryhmä / Arm |
Interventio / HoitoInterventio / Hoito |
|---|---|
|
Kokeellinen: Genicular Nerve Radiofrequency Ablation
Ultrasound-guided diagnostic block of the superomedial, superolateral and inferomedial genicular nerves with 1 ml of 1% lidocaine per nerve. Participants with at least 50% pain reduction within 4 hours undergo ultrasound-guided thermal radiofrequency ablation of the same three nerves (80 C for 90 seconds per nerve) in a single session. Participants with a negative block do not receive radiofrequency and are withdrawn from the study. |
Ultrasound-guided thermal radiofrequency ablation (80 C, 90 seconds per nerve) of the superomedial, superolateral and inferomedial genicular nerves, performed only after a positive diagnostic block (>=50% pain reduction within 4 hours after 1 ml of 1% lidocaine per nerve). |
|
Active Comparator: Intra-articular Hyaluronic Acid
Single intra-articular injection of 6 ml of high molecular weight hyaluronic acid (hylan G-F 20, Synvisc-One, or similar) into the index knee. |
Single 6 ml intra-articular injection of high molecular weight hyaluronic acid into the index knee. |
Mitä tutkimuksessa mitataan?
Ensisijaiset tulostoimenpiteet
Ensisijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
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Change in Knee Pain During Movement (Visual Analogue Scale)
Aikaikkuna: Baseline, 1, 3, 6 and 12 months after the intervention
|
Pain during movement (walking or climbing stairs) in the index knee, measured on a 100 mm visual analogue scale and recorded in cm with one decimal (0 = no pain, 10 = worst imaginable pain). Higher scores indicate worse pain. |
Baseline, 1, 3, 6 and 12 months after the intervention
|
Toissijaiset tulostoimenpiteet
Toissijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
|
Change in Knee Pain at Rest (Visual Analogue Scale)
Aikaikkuna: Baseline, 1, 3, 6 and 12 months after the intervention
|
Pain at rest in the index knee, measured on a 100 mm visual analogue scale and recorded in cm with one decimal (0 = no pain, 10 = worst imaginable pain). Higher scores indicate worse pain. |
Baseline, 1, 3, 6 and 12 months after the intervention
|
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Change in Knee Function (WOMAC)
Aikaikkuna: Baseline, 1, 3, 6 and 12 months after the intervention
|
Western Ontario and McMaster Universities Osteoarthritis Index (Likert 3.1). Total score 0-96 and subscales for pain (0-20), stiffness (0-8) and physical function (0-68). Higher scores indicate worse symptoms and function. |
Baseline, 1, 3, 6 and 12 months after the intervention
|
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Proportion of Participants Achieving the Minimal Clinically Important Difference in Pain
Aikaikkuna: 1, 3, 6 and 12 months after the intervention
|
Percentage of participants with a reduction of at least 2 points from baseline in pain during movement (visual analogue scale, 0-10). |
1, 3, 6 and 12 months after the intervention
|
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Analgesic Consumption
Aikaikkuna: Baseline, 1, 3, 6 and 12 months after the intervention
|
Number of days with analgesic use in the previous 4 weeks (0-28) and most potent analgesic used (none, paracetamol, NSAID, weak opioid, strong opioid). |
Baseline, 1, 3, 6 and 12 months after the intervention
|
|
Number of Participants With Adverse Events
Aikaikkuna: Up to 12 months after the intervention
|
Adverse events related to the diagnostic block, radiofrequency ablation or hyaluronic acid injection, systematically recorded at each visit. |
Up to 12 months after the intervention
|
|
Retreatment or Rescue Treatment
Aikaikkuna: Up to 12 months after the intervention
|
Proportion of participants requiring retreatment, rescue treatment (including corticosteroid injection) or indication of total knee arthroplasty, and time to first retreatment or rescue treatment. |
Up to 12 months after the intervention
|
|
Health-Related Quality of Life (EQ-5D-5L)
Aikaikkuna: Baseline, 6 and 12 months after the intervention
|
EQ-5D-5L descriptive system (5 dimensions, 5 levels; utility index calculated with the Spanish value set, where 1 = full health and higher values indicate better health) and EQ-VAS (0-100, higher scores indicate better health). |
Baseline, 6 and 12 months after the intervention
|
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Rate of Negative Diagnostic Genicular Nerve Blocks
Aikaikkuna: 4 hours after the diagnostic block
|
Percentage of participants allocated to the radiofrequency arm with less than 50% pain reduction within 4 hours after the diagnostic block, who therefore do not receive radiofrequency ablation. |
4 hours after the diagnostic block
|
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Patient Global Assessment
Aikaikkuna: Baseline, 1, 3, 6 and 12 months after the intervention
|
Patient global assessment of the impact of knee osteoarthritis, measured on a 100 mm visual analogue scale (0 = very well, 100 = very poor). Higher scores indicate worse status. |
Baseline, 1, 3, 6 and 12 months after the intervention
|
|
Patient Global Impression of Change (PGIC)
Aikaikkuna: 1, 3, 6 and 12 months after the intervention
|
Single 7-point item from "very much better" to "very much worse" compared with before the study treatment. Responders are participants reporting "much better" or "very much better". |
1, 3, 6 and 12 months after the intervention
|
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Proportion of OMERACT-OARSI Responders
Aikaikkuna: 1, 3, 6 and 12 months after the intervention
|
Responder according to OMERACT-OARSI criteria, based on pain during movement, WOMAC physical function and patient global assessment, each expressed on a 0-100 scale: improvement in pain or function >=50% and >=20 points, or improvement >=20% and >=10 points in at least two of the three domains. |
1, 3, 6 and 12 months after the intervention
|
Yhteistyökumppanit ja tutkijat
Sponsori
Sponsori
Yhteistyökumppanit
Yhteistyökumppanit
Tutkijat
Tutkijat
- Päätutkija: Laura Pallarès Valls, MD, Hospital Universitari Joan XXIII de Tarragona.
Opintojen ennätyspäivät
Opi tärkeimmät päivämäärät
Opiskelun aloitus (Arvioitu)
Opiskelun aloitus
Ensisijainen valmistuminen (Arvioitu)
Ensisijainen valmistuminen
Opintojen valmistuminen (Arvioitu)
Opintojen valmistuminen
Opintoihin ilmoittautumispäivät
Ensimmäinen lähetetty
Ensimmäinen lähetetty
Ensimmäinen toimitettu, joka täytti QC-kriteerit
Ensimmäinen toimitettu, joka täytti QC-kriteerit
Ensimmäinen Lähetetty (Todellinen)
Ensimmäinen Lähetetty
Tutkimustietojen päivitykset
Viimeisin päivitys julkaistu (Todellinen)
Viimeisin päivitys julkaistu
Viimeisin lähetetty päivitys, joka täytti QC-kriteerit
Viimeisin lähetetty päivitys, joka täytti QC-kriteerit
Viimeksi vahvistettu
Viimeksi vahvistettu
Lisää tietoa
Tähän tutkimukseen liittyvät termit
Avainsanat
Muita asiaankuuluvia MeSH-ehtoja
Muut tutkimustunnusnumerot
Muut tutkimustunnusnumerot
- Ceim-116/2026
- 116/2026 (Muu tunniste: CEIm IISPV (Research Ethics Committee) reference number)
Yksittäisten osallistujien tietojen suunnitelma (IPD)
Aiotko jakaa yksittäisten osallistujien tietoja (IPD)?
IPD-suunnitelman kuvaus
Individual participant data will not be shared publicly, as participant consent for data sharing was not obtained and data are protected under the EU General Data Protection Regulation (GDPR). Data will be pseudonymized using participant codes and entered into REDCap, where the statistical analysis will be performed. Aggregated results will be published in peer-reviewed journals.
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