The Efficacy of Ultrasound-Guided Pulsed Radiofrequency of Genicular Nerves in the Treatment of Chronic Knee Pain Due to Severe Degenerative Disease or Previous Total Knee Arthroplasty

Yusuf Erdem, Ender Sir, Yusuf Erdem, Ender Sir

Abstract

BACKGROUND Pulsed radiofrequency of genicular nerves in the management of osteoarthritis related chronic knee pain has recently become a promising treatment. Ultrasonography has replaced fluoroscopic guidance in pain medicine. The aim of this study was to investigate the effect of ultrasound-guided genicular pulsed radiofrequency on knee pain and function in patients who had severe knee osteoarthritis or who had previous knee arthroplasty. MATERIAL AND METHODS The retrospective study included a total of 23 patients with chronic knee pain, of which 17 patients were included in Group I (non-operated), and 6 patients were included in Group II (post-arthroplasty). Treatment was based on ultrasound-guided pulsed radiofrequency of the superior medial, superior lateral, and inferior medial genicular nerves. The Visual Analog Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) scores were assessed before treatment, and at 3 weeks and at 3 months following the procedure. RESULTS Pulsed radiofrequency of the genicular nerves significantly reduced perceived pain and disability in the majority of the patients. The proportion of the patients with improvement of ≥50% in pretreatment VAS scores at 3 weeks and 3 months following treatment were 14 out of 17 patients (82%) and 15 out of 17 patients (88%) in Group 1, and 4 out of 6 patients (67%), 4 out of 6 patients (67%) in Group 2, respectively. CONCLUSIONS Our study results suggest that ultrasound-guided pulsed radiofrequency of genicular nerves is a safe and minimally invasive procedure that significantly alleviates pain and disability in patients with severe degenerative disease or with previous knee arthroplasty.

Conflict of interest statement

Conflict of interests

None.

Figures

Figure 1
Figure 1
(A) Ultrasound image of knee at the level of femoral medial epicondyle. Perineural and periarterial placement of the needle above femur is shown. (B) Ultrasound-guided superior medial genicular nerve pulsed radiofrequency procedure showing ultrasound probe and needle position. (N – superior medial genicular nerve, A – artery).
Figure 2
Figure 2
(A) Ultrasound image of knee at the level of femoral lateral epicondyle. Perineural and periarterial placement of the needle above femur is shown. (B) Ultrasound-guided superior lateral genicular nerve pulsed radiofrequency procedure showing ultrasound probe and needle position. (N – superior lateral genicular nerve, A – artery).
Figure 3
Figure 3
(A) Ultrasound image of knee at the level of tibial medial epicondyle. Perineural and periarterial placement of the needle above femur is shown. (B) Ultrasound-guided inferior medial genicular nerve pulsed radiofrequency procedure showing ultrasound probe and needle position. (N – inferior medial genicular nerve, A – artery).

References

    1. Roos EM, Arden NK. Strategies for the prevention of knee osteoarthritis. Nat Rev Rheumatol. 2016;12:92–101.
    1. Pereira D, Peleteiro B, Araújo J, et al. The effect of osteoarthritis definition on prevalence and incidence estimates: A systematic review. Osteoarthritis Cartilage. 2011;19:1270–85.
    1. Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Clin Geriatr Med. 2010;26:355–69.
    1. Scott DL, Berry H, Capell H, et al. The long-term effects of non-steroidal anti-inflammatory drugs in osteoarthritis of the knee: A randomized placebo-controlled trial. Rheumatology (Oxford) 2000;39:1095–101.
    1. McAlindon TE, Bannuru RR, Sullivan MC, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage. 2014;22:363–88.
    1. Silverwood V, Blagojevic-Bucknall M, Jinks C, et al. Current evidence on risk factors for knee osteoarthritis in older adults: A systematic review and meta-analysis. Osteoarthritis Cartilage. 2015;23:507–15.
    1. Wylde V, Hewlett S, Learmonth ID, Dieppe P. Persistent pain after joint replacement: Prevalence, sensory qualities, and postoperative determinants. Pain. 2011;152:566–72.
    1. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16:494–502.
    1. Bellamy N. WOMAC Osteoarthritis Index: User Guide IX. Brisbane, Queensland: Nicholas Bellamy; 2008.
    1. Mata J, Valentí P, Hernández B, et al. Study protocol for a randomised controlled trial of ultrasound-guided pulsed radiofrequency of the genicular nerves in the treatment of patients with osteoarthritis knee pain. BMJ Open. 2017;7:e016377.
    1. Choi WJ, Hwang SJ, Song JG, et al. Radiofrequency treatment relieves chronic knee osteoarthritis pain: a double-blind randomized controlled trial. Pain. 2011;152:481–87.
    1. Santana Pineda MM, Vanlinthout LE, Moreno Martín A, et al. Analgesic effect and functional improvement caused by radiofrequency treatment of genicular nerves in patients with advanced osteoarthritis of the knee until 1 year following treatment. Reg Anesth Pain Med. 2017;42:62–68.
    1. Protzman NM, Gyi J, Malhotra AD, Kooch JE. Examining the feasibility of radiofrequency treatment for chronic knee pain after total knee arthroplasty. PM R. 2014;6:373–76.
    1. Vas L, Khandagale N, Pai R. Successful management of chronic postsurgical pain following total knee replacement. Pain Med. 2014;15:1781–85.
    1. Cheng PH, Kim HJ, Ottestad E, Narouze S. Ultrasound-guided injections of the knee and hip joints. Tech Reg Anaesth Pain Manag. 2009;13:191–97.
    1. Huntoon MA. Ultrasound in pain medicine: Advanced weaponry or just a fad? Reg Anesth Pain Med. 2009;34:387–88.
    1. Abd-Elsayed A, Anis A, Kaye AD. Radio frequency ablation and pulsed radiofrequency for treating peripheral neuralgias. Curr Pain Headache Rep. 2018;22:5.
    1. Franco CD, Buvanendran A, Petersohn JD, et al. Innervation of the anterior capsule of the human knee: Implications for radiofrequency ablation. Reg Anesth Pain Med. 2015;40:363–68.
    1. Yasar E, Kesikburun S, Kılıç C, et al. Accuracy of ultrasound-guided genicular nerve block: A cadaveric study. Pain Physician. 2015;18:899–904.
    1. Kesikburun S, Yaşar E, Uran A, et al. Ultrasound-guided genicular nerve pulsed radiofrequency treatment for painful knee osteoarthritis: A preliminary report. Pain Physician. 2016;19:751–59.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere