Cooled Radiofrequency Ablation of Genicular Nerves for Knee Osteoarthritis Pain: A Protocol for Patient Selection and Case Series - PubMed (original) (raw)

. 2016 Aug 24;6(6):e39696.

doi: 10.5812/aapm.39696. eCollection 2016 Dec.

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Cooled Radiofrequency Ablation of Genicular Nerves for Knee Osteoarthritis Pain: A Protocol for Patient Selection and Case Series

Rajiv D Reddy et al. Anesth Pain Med. 2016.

Abstract

Background: Chronic knee pain from osteoarthritis (OA) is common in the aging and the obese population. Radiofrequency ablation of the genicular nerves has been introduced as a potential surgery-sparing treatment for chronic knee pain from OA, yet only two outcome studies have been published and optimal patient selection for this procedure has not been established.

Objectives: We describe a standardized protocol for selecting patients for cooled radiofrequency ablation (C-RFA) of the genicular nerves, as well as the clinical outcomes of four patients ages 63-65 years.

Methods: The threshold for selection based on diagnostic genicular nerve block was ≥ 80% pain reduction. Following successful block, C-RFA of the genicular nerves was performed. Outcomes included pain, function, analgesic medication use, opioid use, and progression to total knee arthroplasty at a minimum of 6 month follow up.

Results: C-RFA of the genicular nerves after using the described selection protocol resulted in > 90% pain reduction, improved function and avoidance of surgery at 6 months in all four cases. All opioid and analgesic medication use decreased or was unchanged in all cases. No serious adverse events occurred.

Conclusions: The accompanying case series suggests that this protocol is deserving of randomized, prospective study.

Keywords: Chronic Pain; Knee; Osteoarthritis; Outcome Assessment (Health Care); Radiofrequency Catheter Ablation.

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Figures

Figure 1.

Figure 1.. A, Anterior/Posterior and B, Lateral Fluoroscopic Images of the Final Needle Positions During Diagnostic Block Genicular Nerve Blocks are Shown

The superior lateral site is identified at the confluence of the lateral femoral shaft and the lateral femoral condyle in the A - P plane and the midpoint of the femur in the lateral plane. The superior medial site is identified at the confluence of the medial femoral shaft and the medial femoral condyle in the A - P plane and the midpoint of the femur in the lateral plane. The inferior medial site is identified at the confluence of the medial tibial shaft and the tibial flare in the A - P plane and the midpoint of the tibia in the lateral plane. Of note, the lateral view (1B) shows some obliquity in which the femoral condyles are not perfectly superimposed. This is ideally avoided. The lateral view during electrode placement (shown in Figure 2B) represents a more ideal view with no obliquity.

Figure 2.

Figure 2.. A, Anterior/Posterior and B, Lateral Fluoroscopic Images of the Final Electrode Positions During C-RFA of the Genicular Nerves are Shown

Specific final electrode positions are identical to the final needle positions described in the Figure 1 caption.

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