Radiofrequency denervation or nonoperative treatment for osteoarthritic knee pain: what is more effective?

Background. Knee arthritis and associated chronic pain is a very common problem. Radiofrequency ablation (RFA) of genicular nerves in knee arthritis managament was introduced recently but rigorous studies are lacking.
Objective. To compare the efficacy of RFA of genicular nerves and nonoperative treatment in patients with symptomatic knee arthritis.
Methods. This prospective controlled study included 65 patients with symptomatic knee arthritis and associated knee pain. Thermal RFA of genicular nerves was used in 31 patients under the fluoroscopy guidance (RFA group); complex outpatient conservative treatment was performed in 34 patients (CT group). We compared Visual Analog Scale (VAS) score, functional state of knee joint according to WOMAC scale, Global Perceived Effect of treatment, complications throughout 6 months.
Results. 6 months after treatment, the pain intensity was significantly lower in the RFA group compared to the CT group: 3 [2; 4] vs. 5 [5; 6], respectively (p<0.001). The primary endpoint – a reduction in pain intensity by at least 50% 6 months after treatment – was achieved in 74.2% of patients after RFA, and in 11.8% after CT (p<0.001, Chi-squared=26.0). 6 months after the treatment, WOMAC score in the RFA and CT group were 32.2±5.8 and 45.0±7.8, respectively (p<0.001). Neurological, infectious complications, thermal injuries were not detected.
Conclusion. The study showed that RFA is an effective and safe long-term therapeutic option for managing pain and improving physical function in patients with symptomatic knee OA.

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