Thermal Nerve Radiofrequency Ablation for the Nonsurgical Treatment of Knee Osteoarthritis: A Systematic Literature Review.

BACKGROUND

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)?

METHODS

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.

RESULTS

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.

DISCUSSION

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 OF EVIDENCE

Level I.