From the Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Dr. Chen), the American Academy of Orthopaedic Surgeons, Rosemont, IL (Mr. Mullen, Mr. Casambre, and Ms. Visvabharathy), and the CHI St. Alexius Health, Williston, ND (Dr. Brown).
J Am Acad Orthop Surg. 2021 May 1;29(9):387-396. doi: 10.5435/JAAOS-D-20-00522.
There are roughly 14 million adults in the United States presenting with symptomatic osteoarthritis (OA) of the knee. Nerve radiofrequency ablation (RFA) is a nonsurgical procedure for the management of knee OA symptoms, and no previous systematic review has been performed comparing geniculate nerve RFA to other nonsurgical treatments.
QUESTIONS/PURPOSES: (1) How does geniculate nerve RFA compare with other nonsurgical modalities for patients with knee OA about pain, function, quality of life, and composite scores? and (2) How does geniculate nerve RFA compare with other nonsurgical modalities for patients with knee OA about adverse events (AEs)?
A systematic literature review was conducted within PubMed, EMBASE, and Cochrane Central Register of Controlled Trials to identify all studies from 1966 to 2019 evaluating the relative effectiveness of geniculate nerve thermal (heated or cooled) RFA compared with other nonsurgical treatments for knee OA. Two independent abstractors reviewed and analyzed the literature including comparators such as intra-articular (IA) corticosteroids, IA hyaluronic acid, NSAIDs, acetaminophen (paracetamol), and control/sham procedures. Inclusion was based on the following criteria: English language, human subjects, symptomatic knee OA, and patient-reported outcomes.
Five high-quality and two moderate-quality randomized controlled trials (RCTs) met the inclusion criteria for this review. The results showed consistent agreement across all RCTs in favor of geniculate nerve thermal RFA use for nonsurgical treatment of knee OA. One high-quality RCT and one moderate-quality RCT found geniculate nerve RFA to provide statistically significant outcome improvement compared with control or sham procedures regarding pain, function, quality of life, and composite scores. When compared with IA corticosteroids and hyaluronic acid, geniculate nerve RFA also provided notable improvement in pain, function, and composite scores (visual analog scale, Western Ontario, and McMaster Universities Arthritis Index, and Oxford Knee Score). RFA was markedly favored for all pain and composite outcomes (Western Ontario and McMaster Universities Arthritis Index and visual analog scale). The included RCTs did not report any serious AEs related to geniculate nerve RFA.
These results demonstrate geniculate nerve thermal RFA to be a superior nonsurgical treatment of knee OA compared with NSAIDs and IA corticosteroid injections. None of the RCTs reported any serious AEs with geniculate nerve thermal RFA, as opposed to known cardiovascular, gastrointestinal, and renal AEs for NSAIDs and accelerated cartilage loss and periprosthetic infection risk for IA corticosteroid injections.
Level I.
美国约有 1400 万成年人患有症状性膝关节骨关节炎（OA）。神经射频消融（RFA）是非手术治疗膝关节 OA 症状的一种方法，此前尚无系统评价比较关节内神经 RFA 与其他非手术治疗方法。
问题/目的：（1）对于膝关节 OA 患者，关节内神经 RFA 在疼痛、功能、生活质量和综合评分方面与其他非手术治疗方法相比如何？（2）对于膝关节 OA 患者，关节内神经 RFA 在不良事件（AE）方面与其他非手术治疗方法相比如何？
在 PubMed、EMBASE 和 Cochrane 对照试验中心注册库中进行了系统文献检索，以确定 1966 年至 2019 年期间评估关节内神经热（加热或冷却）RFA 与其他非手术治疗膝关节 OA 相对有效性的所有研究。两名独立的摘要作者对文献进行了回顾和分析，包括比较剂，如关节内（IA）皮质类固醇、IA 透明质酸、非甾体抗炎药（NSAIDs）、对乙酰氨基酚（扑热息痛）和对照/假手术程序。纳入标准基于以下标准：英语、人类受试者、症状性膝关节 OA 和患者报告的结果。
本综述共纳入 5 项高质量和 2 项中等质量的随机对照试验（RCT）。所有 RCT 的结果均一致表明，关节内神经热 RFA 可作为膝关节 OA 的非手术治疗方法。1 项高质量 RCT 和 1 项中等质量 RCT 发现，与对照或假手术相比，关节内神经 RFA 可显著改善疼痛、功能、生活质量和综合评分。与 IA 皮质类固醇和透明质酸相比，关节内神经 RFA 也显著改善了疼痛、功能和综合评分（视觉模拟评分、西部安大略省和麦克马斯特大学关节炎指数以及牛津膝关节评分）。RFA 在所有疼痛和综合结果（西部安大略省和麦克马斯特大学关节炎指数和视觉模拟评分）中均明显占优。纳入的 RCT 均未报告与关节内神经 RFA 相关的任何严重 AE。
这些结果表明，与 NSAIDs 和 IA 皮质类固醇注射相比，关节内神经热 RFA 是治疗膝关节 OA 的一种优越的非手术方法。与 NSAIDs 已知的心血管、胃肠道和肾脏 AE 以及 IA 皮质类固醇注射的加速软骨丢失和假体周围感染风险相比，没有 RCT 报告与关节内神经热 RFA 相关的任何严重 AE。
1 级。
