Safety and efficacy comparison of three- vs four-needle technique in the management of moderate to severe osteoarthritis
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SCIENTIFIC ARTICLE
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 Philip Kin-Wai Wong 1,2 & Nima Kokabi 1,2 & Yi Guo 3 & David Reiter 1,2 & Nickolas Bernard Reimer 4 & Shervin Oskouei 4 & Felix M. Gonzalez 1,2,5 Received: 19 August 2020 / Revised: 16 September 2020 / Accepted: 17 September 2020 # ISS 2020
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 fourneedle technique. Method This retrospective study included 50 consecutive patients with pain from moderate to severe knee OA refractory to antiinflammatory 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. Keywords Knee . Osteoarthritis . Pain . Swelling . Nerve block . C-RFA
This work was selected as scientific paper of the year during the 2019 42nd SSR meeting in Scottdale, AZ, and was subsequently selected for presentation in the International Skeletal Society 2019 Meeting in Vancouver, Canada. * Felix M. Gonzalez [email protected] 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
Department of Radiology and Imaging Sciences, Section of Musculoskeletal Imaging, Emory Orthopaedics and Spine
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