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DOI: 10.1055/s-0042-1745797
Genicular Nerve Ablation Review Using Cooled-Radiofrequency Nerve Ablation
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Abstract
Osteoarthritis (OA) is globally the most prevalent joint disease and causes patients great pain, limited joint mobility, and psychological distress. Short- and long-term therapies like steroid injections and arthroplasty exist, respectively. Joint arthroplasty can effectively treat symptomatic end-stage OA, but most patients do not go through with surgery because they are not qualified, have comorbidities, or do not wish to undergo surgery. As a result, patients can turn to opioid agonists for pain relief, which contributes to the growing opioid epidemic that mars our communities. Cooled radiofrequency ablation (C-RFA) is an effective treatment modality that can alleviate the pain associated with moderate to severe OA, especially in patients who have tried and failed conservative therapy. This review article elucidates the benefits of C-RFA, while also walking through the technical steps to performing the procedure. For patients suffering from debilitating joint OA, especially of the knee, C-RFA is a minimally invasive procedure that ensures pain relief.
Keywords
osteoarthritis - cooled radiofrequency - joint pain - nerve - ablation - interventional radiologyPublication History
Article published online:
30 June 2022
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References
- 1 Cui A, Li H, Wang D, Zhong J, Chen Y, Lu H. Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies. EClinicalMedicine 2020; 29-30: 100587
- 2 Mora JC, Przkora R, Cruz-Almeida Y. Knee osteoarthritis: pathophysiology and current treatment modalities. J Pain Res 2018; 11: 2189-2196
- 3 Chen D, Shen J, Zhao W. et al. Osteoarthritis: toward a comprehensive understanding of pathological mechanism. Bone Res 2017; 5: 16044
- 4 Heidari B. Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I. Caspian J Intern Med 2011; 2 (02) 205-212
- 5 Raud B, Gay C, Guiguet-Auclair C. et al. Level of obesity is directly associated with the clinical and functional consequences of knee osteoarthritis. Sci Rep 2020; 10 (01) 3601
- 6 Zhang W, Doherty M, Peat G. et al. EULAR evidence-based recommendations for the diagnosis of knee osteoarthritis. Ann Rheum Dis 2010; 69 (03) 483-489
- 7 Hsu H, Siwiec RM. Knee Osteoarthritis. In: StatPearls. Treasure Island, FL: StatPearls Publishing LLC; 2021
- 8 Foy CG, Lewis CE, Hairston KG. et al; Look AHEAD Research Group. Intensive lifestyle intervention improves physical function among obese adults with knee pain: findings from the Look AHEAD trial. Obesity (Silver Spring) 2011; 19 (01) 83-93
- 9 Wadden TA, West DS, Delahanty L. et al; Look AHEAD Research Group. The Look AHEAD study: a description of the lifestyle intervention and the evidence supporting it. Obesity (Silver Spring) 2006; 14 (05) 737-752
- 10 DeRogatis M, Anis HK, Sodhi N. et al. Non-operative treatment options for knee osteoarthritis. Ann Transl Med 2019; 7 (Suppl. 07) S245
- 11 Puljak L, Marin A, Vrdoljak D, Markotic F, Utrobicic A, Tugwell P. Celecoxib for osteoarthritis. Cochrane Database Syst Rev 2017; 5 (05) CD009865
- 12 Ghlichloo I, Gerriets V. Nonsteroidal Anti-inflammatory Drugs (NSAIDs). In: StatPearls. Treasure Island, FL: StatPearls Publishing LLC; 2021
- 13 Sun EC, Darnall BD, Baker LC, Mackey S. Incidence of and risk factors for chronic opioid use among opioid-naive patients in the postoperative period. JAMA Intern Med 2016; 176 (09) 1286-1293
- 14 Thorlund JB, Turkiewicz A, Prieto-Alhambra D, Englund M. Opioid use in knee or hip osteoarthritis: a region-wide population-based cohort study. Osteoarthritis Cartilage 2019; 27 (06) 871-877
- 15 Florence CS, Zhou C, Luo F, Xu L. The economic burden of prescription opioid overdose, abuse, and dependence in the United States, 2013. Med Care 2016; 54 (10) 901-906
- 16 Lawal OD, Gold J, Murthy A. et al. Rate and risk factors associated with prolonged opioid use after surgery: a systematic review and meta-analysis. JAMA Netw Open 2020; 3 (06) e207367-e207367
- 17 McAlindon TE, LaValley MP, Harvey WF. et al. Effect of intra-articular triamcinolone vs saline on knee cartilage volume and pain in patients with knee osteoarthritis: a randomized clinical trial. JAMA 2017; 317 (19) 1967-1975
- 18 Hochberg MC, Altman RD, April KT. et al; American College of Rheumatology. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken) 2012; 64 (04) 465-474
- 19 Jevsevar DS. Treatment of osteoarthritis of the knee: evidence-based guideline, 2nd edition. J Am Acad Orthop Surg 2013; 21 (9): 571-576
- 20 McAlindon TE, Bannuru RR, Sullivan MC. et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage 2014; 22 (03) 363-388
- 21 Cram P, Lu X, Kates SL, Singh JA, Li Y, Wolf BR. Total knee arthroplasty volume, utilization, and outcomes among Medicare beneficiaries, 1991-2010. JAMA 2012; 308 (12) 1227-1236
- 22 Skou ST, Roos EM, Laursen MB. et al. A randomized, controlled trial of total knee replacement. N Engl J Med 2015; 373 (17) 1597-1606
- 23 Losina E, Walensky RP, Kessler CL. et al. Cost-effectiveness of total knee arthroplasty in the United States: patient risk and hospital volume. Arch Intern Med 2009; 169 (12) 1113-1121 , discussion 1121–1122
- 24 Wylde V, Sayers A, Lenguerrand E. et al. Preoperative widespread pain sensitization and chronic pain after hip and knee replacement: a cohort analysis. Pain 2015; 156 (01) 47-54
- 25 McGrory BJ, Weber KL, Jevsevar DS, Sevarino K. Surgical management of osteoarthritis of the knee: evidence-based guideline. J Am Acad Orthop Surg 2016; 24 (08) e87-e93
- 26 Kapural L, Mekhail N. Radiofrequency ablation for chronic pain control. Curr Pain Headache Rep 2001; 5 (06) 517-525
- 27 Haines DE, Verow AF. Observations on electrode-tissue interface temperature and effect on electrical impedance during radiofrequency ablation of ventricular myocardium. Circulation 1990; 82 (03) 1034-1038
- 28 Kapural L, Deering JP. A technological overview of cooled radiofrequency ablation and its effectiveness in the management of chronic knee pain. Pain Manag 2020; 10 (03) 133-140
- 29 Cedeno DL, Vallejo A, Kelley CA, Tilley DM, Kumar N. Comparisons of lesion volumes and shapes produced by a radiofrequency system with a cooled, a protruding, or a monopolar probe. Pain Physician 2017; 20 (06) E915-E922
- 30 Vallejo R, Benyamin R, Tilley DM, Kelley CA, Cedeño DL. An ex vivo comparison of cooled-radiofrequency and bipolar-radiofrequency lesion size and the effect of injected fluids. Reg Anesth Pain Med 2014; 39 (04) 312-321
- 31 Choi EJ, Choi YM, Jang EJ, Kim JY, Kim TK, Kim KH. Neural ablation and regeneration in pain practice. Korean J Pain 2016; 29 (01) 3-11
- 32 Wray JK, Dixon B, Przkora R. Radiofrequency Ablation. In: StatPearls. Treasure Island, FL: StatPearls Publishing LLC; 2021
- 33 Haemmerich D. Biophysics of radiofrequency ablation. Crit Rev Biomed Eng 2010; 38 (01) 53-63
- 34 Wong PK, Kokabi N, Guo Y. et al. 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. Skeletal Radiol 2021; 50 (04) 739-750
- 35 Kidd VD, Strum SR, Strum DS, Shah J. Genicular nerve radiofrequency ablation for painful knee arthritis: the why and the how. JBJS Essential Surg Tech 2019; 9 (01) e10
- 36 Cepeda MS, Africano JM, Polo R, Alcala R, Carr DB. What decline in pain intensity is meaningful to patients with acute pain?. Pain 2003; 105 (1-2): 151-157
- 37 Gonzalez FM. Cooled radiofrequency genicular neurotomy. Tech Vasc Interv Radiol 2020; 23 (04) 100706
- 38 Bhatia A, Hoydonckx Y, Peng P, Cohen SP. Radiofrequency procedures to relieve chronic hip pain: an evidence-based narrative review. Reg Anesth Pain Med 2018; 43 (01) 72-83
- 39 Bellini M, Barbieri M. Cooled radiofrequency system relieves chronic knee osteoarthritis pain: the first case-series. Anaesthesiol Intensive Ther 2015; 47 (01) 30-33
- 40 Kapural L, Lee N, Neal K, Burchell M. Long-term retrospective assessment of clinical efficacy of radiofrequency ablation of the knee using a cooled radiofrequency system. Pain Physician 2019; 22 (05) 489-494
- 41 Hunter C, Davis T, Loudermilk E, Kapural L, DePalma M. Cooled radiofrequency ablation treatment of the genicular nerves in the treatment of osteoarthritic knee pain: 18- and 24-month results. Pain Pract 2020; 20 (03) 238-246
- 42 Davis T, Loudermilk E, DePalma M. et al. Prospective, multicenter, randomized, crossover clinical trial comparing the safety and effectiveness of cooled radiofrequency ablation with corticosteroid injection in the management of knee pain from osteoarthritis. Reg Anesth Pain Med 2018; 43 (01) 84-91
- 43 Chen AF, Khalouf F, Zora K. et al. Cooled radiofrequency ablation provides extended clinical utility in the management of knee osteoarthritis: 12-month results from a prospective, multi-center, randomized, cross-over trial comparing cooled radiofrequency ablation to a single hyaluronic acid injection. BMC Musculoskelet Disord 2020; 21 (01) 363
- 44 Deveza LA, Nelson AE, Loeser RF. Phenotypes of osteoarthritis: current state and future implications. Clin Exp Rheumatol 2019; 37 (5, Suppl 120): 64-72
- 45 Rice DA, McNair PJ, Lewis GN, Dalbeth N. The effects of joint aspiration and intra-articular corticosteroid injection on flexion reflex excitability, quadriceps strength and pain in individuals with knee synovitis: a prospective observational study. Arthritis Res Ther 2015; 17 (01) 191
- 46 June RK, Liu-Bryan R, Long F, Griffin TM. Emerging role of metabolic signaling in synovial joint remodeling and osteoarthritis. J Orthop Res 2016; 34 (12) 2048-2058